=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235803487
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALABASAS SURGERY CENTER LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/02/2021
-----------------------------------------------------
Last Update Date | 09/27/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 23621 PARK SORRENTO STE 100
-----------------------------------------------------
City | CALABASAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91302-1395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-797-8000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23621 PARK SORRENTO STE 100
-----------------------------------------------------
City | CALABASAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91302-1395
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-222-2530
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHAIRMAN GOVERNING BODY
-----------------------------------------------------
Name | MR. SCOTT DINOVITZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 818-222-2530
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------