Organization
ELITE OUTPATIENT SURGERY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MOHAMMAD R KHOSRAVI MD (CEO)
(747) 477-1410
Entity
Organization
Contact information
Practice address
2701 W ALAMEDA AVE STE 308, BURBANK, CA 91505-4408
(747) 477-1410
(747) 477-1412
Mailing address
2701 W ALAMEDA AVE STE 308, BURBANK, CA 91505-4408
(747) 477-1410
(747) 477-1412
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
6656
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6656
AAA OF AMBULATORY SURGERY FACILITIES INC
CA
Enumeration date
01/15/2018
Last updated
01/15/2018
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