Basic Information
| Provider Information | |||||||||
| NPI: | 1184029027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME SURGICAL CENTER OF ENCINO, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 N BRAND BLVD STE 900 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912034721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189379969 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5353 BALBOA BLVD | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913162804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189379969 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2014 | ||||||||
| LastUpdateDate: | 07/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | SINGER | ||||||||
| AuthorizedOfficialFirstName: | CAROLINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 8189379969 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PRIME SURGICAL AFFILIATES | ||||||||
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| NPICertificationDate: | 07/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.