Provider Demographics
NPI:1629132360
Name:ENCINO OUTPATIENT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ENCINO OUTPATIENT SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SUHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SIDDIQUI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-986-1037
Mailing Address - Street 1:16311 VENTURA BOULEVARD
Mailing Address - Street 2:SUITE 580
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4314
Mailing Address - Country:US
Mailing Address - Phone:818-986-1037
Mailing Address - Fax:818-986-1800
Practice Address - Street 1:16311 VENTURA BOULEVARD
Practice Address - Street 2:SUITE 580
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4314
Practice Address - Country:US
Practice Address - Phone:818-986-1037
Practice Address - Fax:818-986-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2019-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS551080Medicare ID - Type Unspecified