Provider Demographics
NPI:1063164127
Name:CALABASAS ASC
Entity type:Organization
Organization Name:CALABASAS ASC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:REGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DINOVTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-746-1444
Mailing Address - Street 1:23621 PARK SORRENTO STE 100
Mailing Address - Street 2:
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1395
Mailing Address - Country:US
Mailing Address - Phone:818-746-1444
Mailing Address - Fax:
Practice Address - Street 1:23621 PARK SORRENTO STE 100
Practice Address - Street 2:
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1395
Practice Address - Country:US
Practice Address - Phone:818-746-1444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-20
Last Update Date:2022-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical