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General NPI Number Information
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NPI Number | 1750673398
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Entity Type | Organization
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Legal Business Name | GOLD MED SURGERY CENTER INC.
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Dates
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Enumeration Date | 05/13/2011
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Last Update Date | 05/24/2011
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Provider Practice Location Address
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Address Line | 16311 VENTURA BLVD STE 1010
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City | ENCINO
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State | CA
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Zip | 91436-4345
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Country | US
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Telephone | 818-990-9080
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Fax | 818-990-9758
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Provider Business Mailing Address
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Address Line | 16311 VENTURA BLVD STE 1010
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City | ENCINO
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State | CA
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Zip | 91436-4345
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Country | US
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Telephone | 818-990-9080
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Fax | 818-990-9758
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Authorized Official
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Title or Position | MANAGER
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Name | KRISTINA KUTSINA
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Credential |
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Telephone | 818-990-9080
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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 | CA
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