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General NPI Number Information
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NPI Number | 1932258415
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Entity Type | Organization
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Legal Business Name | GLENDALE ENDOSCOPY CENTER, LLC
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Dates
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Enumeration Date | 01/10/2007
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 824 N GLENDALE AVE
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City | GLENDALE
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State | CA
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Zip | 91206-2127
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Country | US
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Telephone | 818-654-9301
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Fax | 818-654-9305
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Provider Business Mailing Address
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Address Line | 824 N GLENDALE AVE
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City | GLENDALE
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State | CA
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Zip | 91206-2127
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Country | US
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Telephone | 818-500-0523
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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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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