Basic Information
| Provider Information | |||||||||
| NPI: | 1093156937 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | QUALITY CARE SURGERY CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5700 SAN FERNANDO RD | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912022104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186377786 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5700 SAN FERNANDO RD | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912022104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8186377766 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2013 | ||||||||
| LastUpdateDate: | 07/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | ANGULO | ||||||||
| AuthorizedOfficialFirstName: | VENESA | ||||||||
| AuthorizedOfficialMiddleName: | JAMI | ||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8186377786 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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| AuthorizedOfficialCredential: | RN, BSN, MBA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.