1124187208 NPI number — SURGICAL SUITE OF SOUTHERN CALIFORNIA, A MEDICAL CORPORATION

Table of content: (NPI 1124187208)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124187208 NPI number — SURGICAL SUITE OF SOUTHERN CALIFORNIA, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SURGICAL SUITE OF SOUTHERN CALIFORNIA, A MEDICAL CORPORATION
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:
1124187208
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2677
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALAMITOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90720-7677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-935-0073
Provider Business Mailing Address Fax Number:
714-935-0075

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 ELM AVE STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90813-3265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-591-4444
Provider Business Practice Location Address Fax Number:
562-436-7350
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CLEM
Authorized Official First Name:
BARBARA
Authorized Official Middle Name:
JO
Authorized Official Title or Position:
BILLING AND CONTRACTING
Authorized Official Telephone Number:
714-935-0073

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  AAAHC21768 , 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)





Copyright © 2007-2024 www.npivalidator.com