Healthcare Provider Details

I. General information

NPI: 1235131277
Provider Name (Legal Business Name): ALLCARE AMBULATORY SURGERY CTR INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 SEPULVEDA BLVD
VAN NUYS CA
91405-4401
US

IV. Provider business mailing address

6840 SEPULVEDA BLVD
VAN NUYS CA
91405-4401
US

V. Phone/Fax

Practice location:
  • Phone: 818-442-9080
  • Fax: 818-442-9081
Mailing address:
  • Phone: 818-442-9080
  • Fax: 818-442-9081

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: MS. CHARLENE GOFF
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 818-442-9080