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General NPI Number Information
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NPI Number | 1912371352
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Entity Type | Organization
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Legal Business Name | ENT SURGICAL SPECIALISTS INC.
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Dates
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Enumeration Date | 11/23/2015
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Last Update Date | 11/23/2015
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Provider Practice Location Address
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Address Line | 6424 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90048-5347
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Country | US
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Telephone | 310-772-2866
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Fax | 310-421-1880
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Provider Business Mailing Address
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Address Line | 6424 W OLYMPIC BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90048-5347
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Country | US
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Telephone | 310-772-2866
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Fax | 310-421-1880
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Authorized Official
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Title or Position | DIRECTOR OF OPERATION
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Name | NEDA NAZARIAN
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Credential |
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Telephone | 310-772-2866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YX0905X
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Taxonomy Name | Otolaryngology/Facial Plastic Surgery Physician
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License Number | A112498
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License Number State | CA
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