Provider Demographics
NPI:1982077269
Name:ELITE SURGICAL CLINIC, MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ELITE SURGICAL CLINIC, MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CHOBANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-240-1820
Mailing Address - Street 1:1510 S. CENTRAL AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-2582
Mailing Address - Country:US
Mailing Address - Phone:818-240-1820
Mailing Address - Fax:818-240-1021
Practice Address - Street 1:1510 S. CENTRAL AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-2582
Practice Address - Country:US
Practice Address - Phone:818-240-1820
Practice Address - Fax:818-240-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG472240173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty