1033309406 NPI number — WILSHIRE CENTER FOR AMBULATORY SURGERY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033309406 NPI number — WILSHIRE CENTER FOR AMBULATORY SURGERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILSHIRE CENTER FOR AMBULATORY SURGERY, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033309406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/29/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1127 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 1515
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90017-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
213-250-7243
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1127 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
SUITE 1515
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90017-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
213-250-7243
Provider Business Practice Location Address Fax Number:
213-250-8272
Provider Enumeration Date:
07/31/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SAGE
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
MERRICK
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
213-250-5333

Provider Taxonomy Codes

  • Taxonomy code: 261QS0132X , with the licence number:  20A5971 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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