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General NPI Number Information
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NPI Number | 1356543656
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Entity Type | Organization
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Legal Business Name | AVANGUARD SURGERY CENTER, LLC
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Dates
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Enumeration Date | 05/31/2007
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Last Update Date | 04/01/2011
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Provider Practice Location Address
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Address Line | 5620 WILBUR AVE STE 207
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City | TARZANA
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State | CA
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Zip | 91356-1309
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Country | US
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Telephone | 818-344-0070
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Fax |
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Provider Business Mailing Address
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Address Line | 5620 WILBUR AVE STE 207
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City | TARZANA
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State | CA
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Zip | 91356-1309
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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 | MANAGER
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Name | IRENE GAMPEL
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Credential |
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Telephone | 818-355-8868
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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 | 05D1059354
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License Number State | CA
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