1255436028 NPI number — PASADENA SURGERY CENTER INC. A MEDICAL CORPORATION

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 1255436028 NPI number — PASADENA SURGERY CENTER INC. A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PASADENA SURGERY CENTER INC. 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:
1255436028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/17/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10565 CIVIC CENTER DR STE 250
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RANCHO CUCAMONGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91730-3854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-403-6488
Provider Business Mailing Address Fax Number:
626-403-6486

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1035 S FAIR OAKS AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91105-2699
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-403-6488
Provider Business Practice Location Address Fax Number:
626-403-6486
Provider Enumeration Date:
09/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VARGA
Authorized Official First Name:
CLAYTON
Authorized Official Middle Name:
ALEXANDER
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
626-696-1400

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  930000957 , 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)

  • Identifier: 930000957 . This is a "DHS LICENSE NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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