Provider Demographics
NPI:1780277012
Name:INTEGRATIVE OPERATING THEATRES, INC.
Entity type:Organization
Organization Name:INTEGRATIVE OPERATING THEATRES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:VALLECILLOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-273-3007
Mailing Address - Street 1:9675 BRIGHTON WAY STE 380
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5187
Mailing Address - Country:US
Mailing Address - Phone:310-273-3007
Mailing Address - Fax:310-733-1818
Practice Address - Street 1:9675 BRIGHTON WAY STE B1
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5144
Practice Address - Country:US
Practice Address - Phone:310-273-3007
Practice Address - Fax:310-733-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-17
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty