Healthcare Provider Details

I. General information

NPI: 1255314662
Provider Name (Legal Business Name): MAZZOCCO AMBULATORY SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15243 VANOWEN ST
VAN NUYS CA
91405-3605
US

IV. Provider business mailing address

14914 SHERMAN WAY
VAN NUYS CA
91405-2113
US

V. Phone/Fax

Practice location:
  • Phone: 818-787-2020
  • Fax: 818-787-8652
Mailing address:
  • Phone: 818-787-2020
  • Fax: 818-787-8652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. GEORGE M RAJACICH
Title or Position: OWNER
Credential: M.D.
Phone: 818-787-2020