Basic Information
| Provider Information | |||||||||
| NPI: | 1588679179 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SPECIALTY SURGICAL CENTER OF ENCINO LP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8670 WILSHIRE BLVD | ||||||||
| Address2: | STE 301 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902112924 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106596333 | ||||||||
| FaxNumber: | 3106592333 | ||||||||
| Practice Location | |||||||||
| Address1: | 16501 VENTURA BLVD | ||||||||
| Address2: | STE 103 | ||||||||
| City: | ENCINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914362007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3106596333 | ||||||||
| FaxNumber: | 3106592333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | ADLERZ | ||||||||
| AuthorizedOfficialFirstName: | CLIFFORD | ||||||||
| AuthorizedOfficialMiddleName: | G | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT SMBISS ENCINO LLC GENERAL | ||||||||
| AuthorizedOfficialTelephone: | 6152345900 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.