Provider Demographics
NPI:1487252276
Name:TOLUCA LAKE SURGICAL PARTNERS
Entity type:Organization
Organization Name:TOLUCA LAKE SURGICAL PARTNERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN, GOVERNING
Authorized Official - Prefix:MR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TRIPOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-821-3318
Mailing Address - Street 1:10876 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2236
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10876 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-2236
Practice Address - Country:US
Practice Address - Phone:818-821-3318
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-13
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical