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General NPI Number Information
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NPI Number | 1760807127
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Entity Type | Organization
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Legal Business Name | PHYSICIANS SURGERY CENTER AT GLENDALE ADVENTIST, LLC
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Dates
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Enumeration Date | 02/21/2014
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Last Update Date | 02/21/2014
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Provider Practice Location Address
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Address Line | 1500 E CHEVY CHASE DR SUITE #101
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City | GLENDALE
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State | CA
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Zip | 91206-4152
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Country | US
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Telephone | 818-863-4225
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Fax | 818-863-4943
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Provider Business Mailing Address
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Address Line | 1500 E CHEVY CHASE DR SUITE #101
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City | GLENDALE
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State | CA
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Zip | 91206-4152
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Country | US
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Telephone | 818-863-4225
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Fax | 818-863-4943
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MRS. LORA MICHELLE ALTIS-PARKHURST
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Credential | RN
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Telephone | 818-863-4225
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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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