Provider Demographics
NPI:1366422479
Name:VALLEY ENDOSCOPY CENTER LP
Entity type:Organization
Organization Name:VALLEY ENDOSCOPY CENTER LP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:SACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-963-6151
Mailing Address - Street 1:18425 BURBANK BLVD
Mailing Address - Street 2:SUITE 525
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2806
Mailing Address - Country:US
Mailing Address - Phone:818-708-6050
Mailing Address - Fax:818-708-6055
Practice Address - Street 1:18425 BURBANK BLVD
Practice Address - Street 2:SUITE 525
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2806
Practice Address - Country:US
Practice Address - Phone:818-708-6050
Practice Address - Fax:818-708-6055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000809261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA490002521Medicare PIN
CA05C0001296Medicare Oscar/Certification
CAS051296Medicare PIN