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General NPI Number Information
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NPI Number | 1831235878
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Entity Type | Organization
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Legal Business Name | SOUTHERN CALIFORNIA STONE CENTER
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 11/13/2024
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Provider Practice Location Address
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Address Line | 5400 BALBOA BLVD STE 111
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City | ENCINO
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State | CA
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Zip | 91316-5206
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Country | US
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Telephone | 818-784-8975
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Fax | 818-784-7467
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Provider Business Mailing Address
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Address Line | 5400 BALBOA BLVD STE 111
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City | ENCINO
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State | CA
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Zip | 91316-5206
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Country | US
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Telephone | 814-453-6963
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Fax | 310-695-2986
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Authorized Official
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Title or Position | CEO/ OWNER
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Name | CATHERINE LLAVANES
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Credential |
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Telephone | 818-453-6963
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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 | 930000931
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License Number State | CA
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