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General NPI Number Information
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NPI Number | 1407529845
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Entity Type | Organization
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Legal Business Name | PRIME HEALTHCARE ASC - NORTHRIDGE LLC
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Dates
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Enumeration Date | 07/30/2021
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Last Update Date | 09/15/2021
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Provider Practice Location Address
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Address Line | 19331 BUSINESS CENTER DR STE 102
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City | NORTHRIDGE
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State | CA
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Zip | 91324-3533
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Country | US
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Telephone | 818-709-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 3480 E GUASTI RD FL 2
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City | ONTARIO
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State | CA
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Zip | 91761-7684
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Country | US
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Telephone | 310-259-4706
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Fax |
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Authorized Official
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Title or Position | MANAGING ASSOCIATE GENERAL COUNSEL
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Name | CHRISTOPHER DOAN
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Credential |
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Telephone | 310-259-4706
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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 |
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