Provider Demographics
NPI:1831569094
Name:SHERMAN OAKS AMBULATORY SURGERY CENTER
Entity type:Organization
Organization Name:SHERMAN OAKS AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MEHRAS
Authorized Official - Middle Name:
Authorized Official - Last Name:AKHAVAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-990-9074
Mailing Address - Street 1:4940 VAN NUYS BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1739
Mailing Address - Country:US
Mailing Address - Phone:818-990-9074
Mailing Address - Fax:818-990-9076
Practice Address - Street 1:4940 VAN NUYS BLVD STE 103
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1739
Practice Address - Country:US
Practice Address - Phone:818-990-9074
Practice Address - Fax:818-990-9076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-30
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical