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General NPI Number Information
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NPI Number | 1063924017
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Entity Type | Organization
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Legal Business Name | RADIANCE SURGERY CENTER LLC
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Dates
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Enumeration Date | 10/31/2017
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Last Update Date | 10/31/2017
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Provider Practice Location Address
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Address Line | 5170 SEPULVEDA BLVD STE 240
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1190
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Country | US
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Telephone | 818-783-5000
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Fax | 818-783-5001
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Provider Business Mailing Address
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Address Line | 5170 SEPULVEDA BLVD STE 240
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-1190
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Country | US
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Telephone | 818-783-5000
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Fax | 818-783-5001
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. AZIZ BERJIS
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Credential | DPM
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Telephone | 818-783-5000
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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 | 0003011010-0001-0
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License Number State | CA
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