Provider Demographics
NPI:1053719757
Name:NOVAK URGENT CARE AMBULATORY SURGERY INC
Entity type:Organization
Organization Name:NOVAK URGENT CARE AMBULATORY SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:OGANYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-791-9004
Mailing Address - Street 1:80545 US HIGHWAY 111
Mailing Address - Street 2:
Mailing Address - City:INDIO
Mailing Address - State:CA
Mailing Address - Zip Code:92201-8367
Mailing Address - Country:US
Mailing Address - Phone:760-347-9221
Mailing Address - Fax:760-479-5930
Practice Address - Street 1:80545 US HIGHWAY 111
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-8367
Practice Address - Country:US
Practice Address - Phone:760-347-9221
Practice Address - Fax:760-479-5930
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G518830261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical