Provider Demographics
NPI:1619499399
Name:ADVANCED SURGICAL CENTER OF FOOTHILL RANCH LLC
Entity Type:Organization
Organization Name:ADVANCED SURGICAL CENTER OF FOOTHILL RANCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:TCHAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:CASC
Authorized Official - Phone:818-937-9969
Mailing Address - Street 1:130 N BRAND BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4625
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27462 PORTOLA PKWY STE 101
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2838
Practice Address - Country:US
Practice Address - Phone:818-937-9969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED SURGICAL CENTERS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical