1174315154 NPI number — DISC SURGERY CENTER AT TARZANA, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174315154 NPI number — DISC SURGERY CENTER AT TARZANA, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISC SURGERY CENTER AT TARZANA, LLC
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:
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:
1174315154
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/19/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 JAMBOREE RD STE 2300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92660-2904
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-988-7828
Provider Business Mailing Address Fax Number:
949-988-7869

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5223 LINDLEY AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
747-254-3480
Provider Business Practice Location Address Fax Number:
747-254-3481
Provider Enumeration Date:
05/19/2025

Additional Information

Authorized Official

Authorized Official Last Name:
REITER
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
JANE
Authorized Official Title or Position:
NATIONAL VP OF ASC OPERATIONS
Authorized Official Telephone Number:
310-710-4189

Provider Taxonomy Codes

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

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





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