Provider Demographics
NPI:1063924017
Name:RADIANCE SURGERY CENTER LLC
Entity type:Organization
Organization Name:RADIANCE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:AZIZ
Authorized Official - Middle Name:
Authorized Official - Last Name:BERJIS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:818-783-5000
Mailing Address - Street 1:5170 SEPULVEDA BLVD STE 240
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-1190
Mailing Address - Country:US
Mailing Address - Phone:818-783-5000
Mailing Address - Fax:818-783-5001
Practice Address - Street 1:5170 SEPULVEDA BLVD STE 240
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-1190
Practice Address - Country:US
Practice Address - Phone:818-783-5000
Practice Address - Fax:818-783-5001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0003011010-0001-0261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical