MEDICARE: CENTRAL SURGICAL CENTER PC A CALIFORNIA PROFESSIONAL MEDICAL CO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1699189894
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL SURGICAL CENTER PC A CALIFORNIA PROFESSIONAL MEDICAL CO

Provider Business Mailing Address
First Line	:	503 N CENTRAL AVE
Second Line	:	SUITE 201
City	:	GLENDALE
State	:	CA
Zip	:	91203-1901
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	503 N CENTRAL AVE
Second Line	:	SUITE 201
City	:	GLENDALE
State	:	CA
Zip	:	91203-1901
Country	:	US
Telephone Number	:	818-265-9499
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	MICHAEL TAHERY
Credential	:	M.D.
Telephone Number	:	818-265-9499

Provider Enumeration Date	:	06/16/2014
Last Update Date	:	06/16/2014

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