Provider Demographics
NPI:1821127275
Name:ELITE SURGERY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:ELITE SURGERY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BIJAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROUKHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-501-5353
Mailing Address - Street 1:16311 VENTURA BLVD
Mailing Address - Street 2:SUITE 1085
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2124
Mailing Address - Country:US
Mailing Address - Phone:818-501-5353
Mailing Address - Fax:818-501-2723
Practice Address - Street 1:16311 VENTURA BLVD
Practice Address - Street 2:SUITE 1085
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2124
Practice Address - Country:US
Practice Address - Phone:818-501-5353
Practice Address - Fax:818-501-2723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-03
Last Update Date:2018-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051736Medicare ID - Type Unspecified