1316579055 NPI number — NOVA AMBULATORY SURGERY CENTER LP

Table of content: (NPI 1316579055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316579055 NPI number — NOVA AMBULATORY SURGERY CENTER LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NOVA AMBULATORY SURGERY CENTER LP
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:
1316579055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3129
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TORRANCE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90510-3129
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-792-3914
Provider Business Mailing Address Fax Number:
855-898-4055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4542 LAS POSAS RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMARILLO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93010-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-585-5004
Provider Business Practice Location Address Fax Number:
805-484-3099
Provider Enumeration Date:
02/11/2020

Additional Information

Authorized Official

Authorized Official Last Name:
PETTYJOHN
Authorized Official First Name:
ELIDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING ACCT MANAGER
Authorized Official Telephone Number:
512-454-5911

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)





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