Provider Demographics
NPI:1497733661
Name:CHEVY CHASE AMBULATORY CENTER LP
Entity Type:Organization
Organization Name:CHEVY CHASE AMBULATORY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAFFI
Authorized Official - Middle Name:
Authorized Official - Last Name:SARKISSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-265-2227
Mailing Address - Street 1:801 S CHEVY CHASE DR
Mailing Address - Street 2:SUITE #106
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-4431
Mailing Address - Country:US
Mailing Address - Phone:818-265-2275
Mailing Address - Fax:818-649-1034
Practice Address - Street 1:801 S CHEVY CHASE DR
Practice Address - Street 2:SUITE #106
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-4431
Practice Address - Country:US
Practice Address - Phone:818-265-2275
Practice Address - Fax:818-649-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000021261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051724Medicare PIN