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General NPI Number Information
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NPI Number | 1144574484
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Entity Type | Organization
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Legal Business Name | CALIFORNIA SURGICAL MULTI-SPECIALTY GROUP INC.
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Dates
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Enumeration Date | 11/08/2012
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Last Update Date | 11/08/2012
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Provider Practice Location Address
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Address Line | 800 S CENTRAL AVE 212
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City | GLENDALE
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State | CA
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Zip | 91204-4370
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Country | US
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Telephone | 818-247-2000
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Fax | 818-247-2121
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Provider Business Mailing Address
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Address Line | 800 S CENTRAL AVE 212
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City | GLENDALE
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State | CA
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Zip | 91204-4370
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Country | US
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Telephone | 818-247-2000
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Fax | 818-247-2121
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GEVORG MUTAFYAN
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Credential | M.D.
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Telephone | 818-247-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A92473
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License Number State | CA
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