Basic Information
| Provider Information | |||||||||
| NPI: | 1366554495 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTURY CITY ENDOSCOPY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2080 CENTURY PARK E | ||||||||
| Address2: | #1200 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900672001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102778900 | ||||||||
| FaxNumber: | 3102867124 | ||||||||
| Practice Location | |||||||||
| Address1: | 2080 CENTURY PARK E | ||||||||
| Address2: | #1200 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900672001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102778900 | ||||||||
| FaxNumber: | 3102867124 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 08/07/2008 | ||||||||
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| AuthorizedOfficialLastName: | ROSOFF | ||||||||
| AuthorizedOfficialFirstName: | SAUL | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3102778900 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0800X | 261QA1903X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Endoscopy |
No ID Information.