Provider Demographics
NPI:1225385867
Name:GLENDALE SURGICAL ASSOCIATES, LP
Entity Type:Organization
Organization Name:GLENDALE SURGICAL ASSOCIATES, LP
Other - Org Name:PACIFIC COAST OMS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFAURIE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-241-4217
Mailing Address - Street 1:23206 LYONS AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2672
Mailing Address - Country:US
Mailing Address - Phone:661-259-9750
Mailing Address - Fax:661-259-9797
Practice Address - Street 1:23206 LYONS AVE STE 210
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-2672
Practice Address - Country:US
Practice Address - Phone:661-259-9750
Practice Address - Fax:661-259-9797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GLENDALE SURGICAL ASSOCIATES, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-14
Last Update Date:2012-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty