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General NPI Number Information
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NPI Number | 1184817173
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Entity Type | Organization
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Legal Business Name | DAVTYAN SURGICAL ASSOCIATES, INC
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 11847 WILSHIRE BLVD SUITE 200
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City | LOS ANGELES
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State | CA
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Zip | 90025-6620
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Country | US
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Telephone | 913-312-3719
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Fax | 913-312-3715
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Provider Business Mailing Address
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Address Line | 10700 SIKES PL SUITE 120
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City | CHARLOTTE
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State | NC
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Zip | 28277-8144
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Country | US
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Telephone | 704-246-0700
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Fax | 704-246-0705
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Authorized Official
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Title or Position | CHIEF CLINICAL OFFICER
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Name | MRS. CAROLE SUSAN GUINANE
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Credential | RN
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Telephone | 704-246-0700
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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 | CA
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