Provider Demographics
NPI:1821481482
Name:LA TOP SURGERY CENTER LLC
Entity Type:Organization
Organization Name:LA TOP SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER/OWNER.
Authorized Official - Prefix:DR
Authorized Official - First Name:GEVORG
Authorized Official - Middle Name:
Authorized Official - Last Name:MUTAFYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-424-8568
Mailing Address - Street 1:800 S CENTRAL AVE # 100A2
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-4370
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 S CENTRAL AVE # 100A2
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-4370
Practice Address - Country:US
Practice Address - Phone:818-424-8568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5729OtherAAAASF