Provider Demographics
NPI:1497994941
Name:SUNRISE SURGICAL CENTER MIRABADI PARVIN GEN PTR
Entity Type:Organization
Organization Name:SUNRISE SURGICAL CENTER MIRABADI PARVIN GEN PTR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PARVIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIRABADI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:8187-820-0004
Mailing Address - Street 1:4940 VAN NUYS BLVD
Mailing Address - Street 2:100
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1700
Mailing Address - Country:US
Mailing Address - Phone:818-782-0004
Mailing Address - Fax:818-782-0555
Practice Address - Street 1:4940 VAN NUYS BLVD
Practice Address - Street 2:100
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1700
Practice Address - Country:US
Practice Address - Phone:818-782-0004
Practice Address - Fax:818-782-0555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-06
Last Update Date:2015-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical