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General NPI Number Information
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NPI Number | 1619414018
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Entity Type | Organization
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Legal Business Name | DIESEL SURGERY CENTER
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Dates
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Enumeration Date | 01/23/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 11645 WILSHIRE BLVD STE 987
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City | LOS ANGELES
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State | CA
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Zip | 90025-6814
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Country | US
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Telephone | 310-393-9359
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Fax |
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Provider Business Mailing Address
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Address Line | 11645 WILSHIRE BLVD STE 987
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City | LOS ANGELES
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State | CA
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Zip | 90025-6814
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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 | MEDICAL DIRECTOR
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Name | DAVID GHOZLAND
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Credential | M.D.
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Telephone | 310-393-9359
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | A86726
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License Number State | CA
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Taxonomy #2
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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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