Provider Demographics
NPI:1326613514
Name:TARZANA AMBULATORY SURGICAL INSTITUTE
Entity Type:Organization
Organization Name:TARZANA AMBULATORY SURGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATOR
Authorized Official - Phone:818-791-1398
Mailing Address - Street 1:5620 WILBUR AVE STE 305
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-1311
Mailing Address - Country:US
Mailing Address - Phone:818-791-1398
Mailing Address - Fax:818-791-1721
Practice Address - Street 1:5620 WILBUR AVE STE 305
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-1311
Practice Address - Country:US
Practice Address - Phone:818-791-1398
Practice Address - Fax:818-791-1721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-21
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical