Provider Demographics
NPI:1437156379
Name:SAN FERNANDO VALLEY SURGERY CENTER, LP
Entity Type:Organization
Organization Name:SAN FERNANDO VALLEY SURGERY CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENETHA
Authorized Official - Middle Name:D
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-763-3893
Mailing Address - Street 1:11550 INDIAN HILLS RD
Mailing Address - Street 2:SUITE 160
Mailing Address - City:MISSION HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91345-1239
Mailing Address - Country:US
Mailing Address - Phone:818-256-2100
Mailing Address - Fax:818-256-2157
Practice Address - Street 1:11550 INDIAN HILLS RD
Practice Address - Street 2:SUITE 160
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-1239
Practice Address - Country:US
Practice Address - Phone:818-256-2100
Practice Address - Fax:818-256-2157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR51052HMedicaid
CAS551055BMedicare PIN
CASUR51052HMedicaid