1184817173 NPI number — DAVTYAN SURGICAL ASSOCIATES, INC

Table of content: (NPI 1184817173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184817173 NPI number — DAVTYAN SURGICAL ASSOCIATES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DAVTYAN SURGICAL ASSOCIATES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1184817173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10700 SIKES PL
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28277-8144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-246-0700
Provider Business Mailing Address Fax Number:
704-246-0705

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11847 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90025-6620
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-312-3719
Provider Business Practice Location Address Fax Number:
913-312-3715
Provider Enumeration Date:
08/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUINANE
Authorized Official First Name:
CAROLE
Authorized Official Middle Name:
SUSAN
Authorized Official Title or Position:
CHIEF CLINICAL OFFICER
Authorized Official Telephone Number:
704-246-0700

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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