Basic Information
| Provider Information | |||||||||
| NPI: | 1316342579 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ENCINO SURGICAL CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7230 MEDICAL CENTER DR STE 500 | ||||||||
| Address2: | |||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913074024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183487246 | ||||||||
| FaxNumber: | 8183487248 | ||||||||
| Practice Location | |||||||||
| Address1: | 16260 VENTURA BLVD | ||||||||
| Address2: | SUITE 800 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183487246 | ||||||||
| FaxNumber: | 8183487248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/30/2014 | ||||||||
| LastUpdateDate: | 04/22/2021 | ||||||||
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| AuthorizedOfficialLastName: | LALA | ||||||||
| AuthorizedOfficialFirstName: | VIMAL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8183487246 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 04/22/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.