Organization
BROADWAY LASER SURGICAL INSTITUTE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ABRAHAM EBBIE SOROUDI M.D. (MEDICAL DIRECTOR)
(310) 474-2010
Entity
Organization
Contact information
Practice address
1100 E BROADWAY STE 201, GLENDALE, CA 91205-1380
(818) 449-3937
Mailing address
1100 E BROADWAY STE 201, GLENDALE, CA 91205-1380
(818) 449-3937
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
05/30/2018
Last updated
04/27/2020
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