Basic Information
| Provider Information | |||||||||
| NPI: | 1184073884 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RADIANCE SURGERY CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5170 SEPULVEDA BLVD STE 240 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189958702 | ||||||||
| FaxNumber: | 8189958703 | ||||||||
| Practice Location | |||||||||
| Address1: | 5170 SEPULVEDA BLVD STE 240 | ||||||||
| Address2: | |||||||||
| City: | SHERMAN OAKS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914031190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189958702 | ||||||||
| FaxNumber: | 8189958703 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2016 | ||||||||
| LastUpdateDate: | 06/03/2016 | ||||||||
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| AuthorizedOfficialLastName: | BERJIS | ||||||||
| AuthorizedOfficialFirstName: | AZIZ | ||||||||
| AuthorizedOfficialMiddleName: | H. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8189958702 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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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.