Provider Demographics
NPI:1912371352
Name:ENT SURGICAL SPECIALISTS INC.
Entity Type:Organization
Organization Name:ENT SURGICAL SPECIALISTS INC.
Other - Org Name:ENT SURGICAL SPECIALISTS INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:
Authorized Official - First Name:NEDA
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-772-2866
Mailing Address - Street 1:6424 W OLYMPIC BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5347
Mailing Address - Country:US
Mailing Address - Phone:310-772-2866
Mailing Address - Fax:310-421-1880
Practice Address - Street 1:6424 W OLYMPIC BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5347
Practice Address - Country:US
Practice Address - Phone:310-772-2866
Practice Address - Fax:310-421-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-23
Last Update Date:2015-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112498207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEY591AMedicare PIN