Provider Demographics
NPI:1578637757
Name:WOODLAKE AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:WOODLAKE AMBULATORY SURGERY CENTER
Other - Org Name:TOP SURGEONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER AND OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OMIDI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-883-3162
Mailing Address - Street 1:9001 WILSHIRE BLVD
Mailing Address - Street 2:STE 106
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1838
Mailing Address - Country:US
Mailing Address - Phone:310-273-8885
Mailing Address - Fax:310-273-8662
Practice Address - Street 1:7320 WOODLAKE AVE
Practice Address - Street 2:STE 320
Practice Address - City:WEST HILLS
Practice Address - State:CA
Practice Address - Zip Code:91307-1404
Practice Address - Country:US
Practice Address - Phone:818-883-3162
Practice Address - Fax:818-883-2900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-20
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051829OtherPROVIDER TRANACTION NUMBER (PTAN)