Provider Demographics
NPI:1861923625
Name:MID-VALLEY SURGICAL CENTER, INC.
Entity type:Organization
Organization Name:MID-VALLEY SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:POLOSAJIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-454-3638
Mailing Address - Street 1:7640 TAMPA AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-1700
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7640 TAMPA AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-1700
Practice Address - Country:US
Practice Address - Phone:818-454-3638
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-23
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical