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General NPI Number Information
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NPI Number | 1013438563
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Entity Type | Organization
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Legal Business Name | VENTANA SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 10/27/2020
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Provider Practice Location Address
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Address Line | 18133 VENTURA BLVD STE 400
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City | TARZANA
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State | CA
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Zip | 91356-3645
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Country | US
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Telephone | 818-462-0280
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Fax | 818-668-6239
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Provider Business Mailing Address
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Address Line | 18133 VENTURA BLVD STE 400
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City | TARZANA
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State | CA
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Zip | 91356-3645
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Country | US
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Telephone | 818-462-0280
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Fax | 818-668-6239
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Authorized Official
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Title or Position | OFFICER / AUTHORIZED OFFICIAL
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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