Provider Demographics
NPI:1790834612
Name:SHERMAN OAKS SURGERY CENTER INC. A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SHERMAN OAKS SURGERY CENTER INC. A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:H
Authorized Official - Last Name:BERJIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-995-8702
Mailing Address - Street 1:5170 SEPULVEDA BLVD
Mailing Address - Street 2:STE 140
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-995-8702
Mailing Address - Fax:818-995-8703
Practice Address - Street 1:5170 SEPULVEDA BLVD
Practice Address - Street 2:#140
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1171
Practice Address - Country:US
Practice Address - Phone:818-728-4833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2016-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9300946261QA1903X
CA975-4776372261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA71385Medicare UPIN
CAA27376Medicare UPIN
CAS051477Medicare ID - Type Unspecified
CAG45756Medicare UPIN