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General NPI Number Information
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NPI Number | 1295106953
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Entity Type | Organization
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Legal Business Name | ADVANCED SURGICAL CENTER OF ENCINO, LLC
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Dates
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Enumeration Date | 10/07/2015
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Last Update Date | 07/03/2024
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Provider Practice Location Address
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Address Line | 5353 BALBOA BLVD SUITE 302
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City | ENCINO
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State | CA
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Zip | 91316-2804
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Country | US
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Telephone | 818-946-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 550 N BRAND BLVD STE 900
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City | GLENDALE
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State | CA
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Zip | 91203-4721
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | CAROLINE NICOLE SINGER
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Credential | CASC
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Telephone | 818-937-9969
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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