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General NPI Number Information
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NPI Number | 1376779363
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Entity Type | Organization
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Legal Business Name | TARZANA SURGICAL SPECIALISTS INC
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Dates
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Enumeration Date | 06/03/2009
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Last Update Date | 06/08/2009
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Provider Practice Location Address
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Address Line | 18425 BURBANK BLVD SUITE 105
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City | TARZANA
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State | CA
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Zip | 91356-2806
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Country | US
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Telephone | 818-654-0595
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Fax |
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Provider Business Mailing Address
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Address Line | 18425 BURBANK BLVD SUITE 105
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City | TARZANA
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State | CA
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Zip | 91356-2806
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Country | US
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Telephone | 818-654-0595
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MOKHTAR G MIKHAIL
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Credential | MD
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Telephone | 818-654-0590
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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 |
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License Number State |
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