1356356133 NPI number — INLAND VALLEY SURGICAL CENTER

Table of content: (NPI 1356356133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356356133 NPI number — INLAND VALLEY SURGICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INLAND VALLEY SURGICAL CENTER
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:
NISSANOFF SURGICAL CENTER
Provider Other Organization Name Type Code:
4
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:
1356356133
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 502530
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92150-2530
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-451-2280
Provider Business Mailing Address Fax Number:
858-451-2006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15525 POMERADO RD., SUITE E6
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POWAY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-451-2280
Provider Business Practice Location Address Fax Number:
858-451-2006
Provider Enumeration Date:
07/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NISSANOFF
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO/OWNER
Authorized Official Telephone Number:
858-451-2280

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 23424 . This is a "AAAHC" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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