Provider Demographics
NPI:1902858012
Name:NORTH PENINSULA SURGICAL CENTER LP
Entity Type:Organization
Organization Name:NORTH PENINSULA SURGICAL CENTER LP
Other - Org Name:TORRANCE OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.O.O.
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:TCHAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-937-9969
Mailing Address - Street 1:130 N. BRAND BLVD, STE 303
Mailing Address - Street 2:PRIME MSO/NORTH PENINSULA SURGICAL CENTER
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203
Mailing Address - Country:US
Mailing Address - Phone:818-937-9969
Mailing Address - Fax:818-937-9968
Practice Address - Street 1:22525 MAPLE AVE
Practice Address - Street 2:STE 101
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-2700
Practice Address - Country:US
Practice Address - Phone:310-602-5480
Practice Address - Fax:858-225-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051720Medicare ID - Type UnspecifiedASC