1912371352 NPI number — ENT SURGICAL SPECIALISTS INC.

Table of content: MS. CLARE DEERING DELOSKEY LCSW (NPI 1003169806)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912371352 NPI number — ENT SURGICAL SPECIALISTS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ENT SURGICAL SPECIALISTS 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:
1912371352
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6424 W OLYMPIC BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90048-5347
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-772-2866
Provider Business Mailing Address Fax Number:
310-421-1880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6424 W OLYMPIC BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90048-5347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-772-2866
Provider Business Practice Location Address Fax Number:
310-421-1880
Provider Enumeration Date:
11/23/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NAZARIAN
Authorized Official First Name:
NEDA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATION
Authorized Official Telephone Number:
310-772-2866

Provider Taxonomy Codes

  • Taxonomy code: 207YX0905X , with the licence number:  A112498 , 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)