Provider Demographics
NPI:1639568108
Name:SPECIALTY OUTPATIENT SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SPECIALTY OUTPATIENT SURGERY CENTER, LLC
Other - Org Name:SPECIALTY OUTPATIENT SURGERY CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JALIL
Authorized Official - Middle Name:
Authorized Official - Last Name:RASHTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-844-8700
Mailing Address - Street 1:PO BOX 251720
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91225-1720
Mailing Address - Country:US
Mailing Address - Phone:818-844-8700
Mailing Address - Fax:877-807-8246
Practice Address - Street 1:200 S LOUISE ST
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91205-1637
Practice Address - Country:US
Practice Address - Phone:818-844-8700
Practice Address - Fax:877-807-8246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical