Provider Demographics
NPI:1558132316
Name:LIFE SURGICAL ONCOLOGY, PC
Entity Type:Organization
Organization Name:LIFE SURGICAL ONCOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AVO
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTINYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MS
Authorized Official - Phone:818-606-2200
Mailing Address - Street 1:1439 COLINA DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91208-2410
Mailing Address - Country:US
Mailing Address - Phone:818-606-2200
Mailing Address - Fax:
Practice Address - Street 1:4515 CASTLE RD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-1437
Practice Address - Country:US
Practice Address - Phone:818-484-8049
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-11
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal SurgeryGroup - Multi-Specialty