Provider Demographics
NPI:1821250762
Name:TARZANA MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:TARZANA MEDICAL CENTER LLC
Other - Org Name:PROVIDENCE CEDARS-SINAI TARZANA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST SECRETARY FOR ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:W
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:425-525-5392
Mailing Address - Street 1:18321 CLARK ST
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3501
Mailing Address - Country:US
Mailing Address - Phone:818-881-0800
Mailing Address - Fax:818-708-5382
Practice Address - Street 1:18321 CLARK ST
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3501
Practice Address - Country:US
Practice Address - Phone:310-303-7496
Practice Address - Fax:310-303-7575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-01
Last Update Date:2020-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZA1921AOtherBLUE SHIELD
CA050761Medicare UPIN
CA050761Medicare Oscar/Certification
CA050761Medicare PIN
CAZZZA1921AOtherBLUE SHIELD