Provider Demographics
NPI:1295106953
Name:ADVANCED SURGICAL CENTER OF ENCINO, LLC
Entity type:Organization
Organization Name:ADVANCED SURGICAL CENTER OF ENCINO, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:SINGER
Authorized Official - Suffix:
Authorized Official - Credentials:CASC
Authorized Official - Phone:818-937-9969
Mailing Address - Street 1:550 N BRAND BLVD STE 900
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91203-4721
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5353 BALBOA BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-2804
Practice Address - Country:US
Practice Address - Phone:818-946-7800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED SURGICAL CENTERS, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-07
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty