Provider Demographics
NPI:1396224143
Name:CENTURY PARK AMBULATORY SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:CENTURY PARK AMBULATORY SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-440-2020
Mailing Address - Street 1:2080 CENTURY PARK E STE 1111
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2029
Mailing Address - Country:US
Mailing Address - Phone:650-440-2020
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 1111
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2029
Practice Address - Country:US
Practice Address - Phone:650-440-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-13
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty