Provider Demographics
NPI:1932786928
Name:ACTIVE SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:ACTIVE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MAXIM
Authorized Official - Middle Name:
Authorized Official - Last Name:MORADIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-338-6860
Mailing Address - Street 1:PO BOX 8323
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91224-0323
Mailing Address - Country:US
Mailing Address - Phone:818-338-6860
Mailing Address - Fax:888-425-9079
Practice Address - Street 1:51 N 5TH AVE STE 301D
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3710
Practice Address - Country:US
Practice Address - Phone:626-460-1096
Practice Address - Fax:888-425-9079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty