Provider Demographics
NPI:1750673398
Name:GOLD MED SURGERY CENTER INC.
Entity Type:Organization
Organization Name:GOLD MED SURGERY CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTSINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-990-9080
Mailing Address - Street 1:16311 VENTURA BLVD STE 1010
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4345
Mailing Address - Country:US
Mailing Address - Phone:818-990-9080
Mailing Address - Fax:818-990-9758
Practice Address - Street 1:16311 VENTURA BLVD STE 1010
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4345
Practice Address - Country:US
Practice Address - Phone:818-990-9080
Practice Address - Fax:818-990-9758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-13
Last Update Date:2011-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical