Provider Demographics
NPI:1508360322
Name:NORTH HOLLYWOOD SURGERY CENTER, A CALIFORNIA CORPORATION
Entity Type:Organization
Organization Name:NORTH HOLLYWOOD SURGERY CENTER, A CALIFORNIA CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINASTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-762-8702
Mailing Address - Street 1:12134 VICTORY BLVD STE E
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3205
Mailing Address - Country:US
Mailing Address - Phone:844-772-4752
Mailing Address - Fax:
Practice Address - Street 1:12134 VICTORY BLVD STE E
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3205
Practice Address - Country:US
Practice Address - Phone:844-772-4752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-19
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty