1578637757 NPI number — WOODLAKE AMBULATORY SURGERY CENTER

Table of content: (NPI 1578637757)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578637757 NPI number — WOODLAKE AMBULATORY SURGERY CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOODLAKE AMBULATORY SURGERY CENTER
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:
TOP SURGEONS
Provider Other Organization Name Type Code:
3
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:
1578637757
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/07/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9001 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
STE 106
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90211-1838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-273-8885
Provider Business Mailing Address Fax Number:
310-273-8662

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7320 WOODLAKE AVE
Provider Second Line Business Practice Location Address:
STE 320
Provider Business Practice Location Address City Name:
WEST HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91307-1404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-883-3162
Provider Business Practice Location Address Fax Number:
818-883-2900
Provider Enumeration Date:
11/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OMIDI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER AND OPERATOR
Authorized Official Telephone Number:
818-883-3162

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)

  • Identifier: S051829 . This is a "PROVIDER TRANACTION NUMBER (PTAN)" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com