Provider Demographics
NPI:1518106582
Name:LIBBIT SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:LIBBIT SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:DIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUPERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-788-4341
Mailing Address - Street 1:16260 VENTURA BLVD
Mailing Address - Street 2:SUITE 309A
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-788-4341
Mailing Address - Fax:818-906-7626
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:SUITE 309A
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436
Practice Address - Country:US
Practice Address - Phone:818-788-4341
Practice Address - Fax:818-906-7626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-13
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical