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General NPI Number Information
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NPI Number | 1700176963
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Entity Type | Organization
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Legal Business Name | DIAMOND SURGERY CENTER, INC.
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Dates
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Enumeration Date | 04/08/2011
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Last Update Date | 04/08/2011
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Provider Practice Location Address
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Address Line | 16250 VENTURA BLVD SUITE 345
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City | ENCINO
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State | CA
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Zip | 91436-2204
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Country | US
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Telephone | 818-528-2559
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Fax | 818-528-2588
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Provider Business Mailing Address
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Address Line | 16250 VENTURA BLVD SUITE 345
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City | ENCINO
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State | CA
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Zip | 91436-2204
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Country | US
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Telephone | 818-528-2559
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Fax | 818-528-2588
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROYA DARDASHTI
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Credential | MD
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Telephone | 818-528-2559
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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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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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