Provider Demographics
NPI:1184817173
Name:DAVTYAN SURGICAL ASSOCIATES, INC
Entity Type:Organization
Organization Name:DAVTYAN SURGICAL ASSOCIATES, INC
Other - Org Name:NEWHOPE BARIATRICS WEIGHT LOSS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF CLINICAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROLE
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:GUINANE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:704-246-0700
Mailing Address - Street 1:10700 SIKES PL
Mailing Address - Street 2:SUITE 120
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-8144
Mailing Address - Country:US
Mailing Address - Phone:704-246-0700
Mailing Address - Fax:704-246-0705
Practice Address - Street 1:11847 WILSHIRE BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-6620
Practice Address - Country:US
Practice Address - Phone:913-312-3719
Practice Address - Fax:913-312-3715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-22
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical