Organization
REJUVENATION SURGICENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SID KAMRAVA MD (MEDICAL DIRECTOR)
(818) 783-5058
Entity
Organization
Contact information
Practice address
17525 VENTURA BLVD, SUITE 101, ENCINO, CA 91316-3843
(818) 783-5050
(818) 783-5059
Mailing address
17525 VENTURA BLVD, SUITE 101, ENCINO, CA 91316-3843
(818) 783-5059
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
FNP36955
CA
Other
Enumeration date
05/22/2008
Last updated
05/22/2008
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