Provider Demographics
NPI:1093927725
Name:FOOTHILL RANCH SURGERY & MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:FOOTHILL RANCH SURGERY & MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MISS
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TCHAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:CASC
Authorized Official - Phone:818-937-9969
Mailing Address - Street 1:27462 PORTOLA PARKWAY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FOOTHILL RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92610
Mailing Address - Country:US
Mailing Address - Phone:949-900-1340
Mailing Address - Fax:949-900-1341
Practice Address - Street 1:130 N BRAND BLVD
Practice Address - Street 2:SUITE 303
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2644
Practice Address - Country:US
Practice Address - Phone:818-937-9969
Practice Address - Fax:818-937-9968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-04
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical