1487734695 NPI number — PALOS VERDES AMBULATORY SURGERY CENTER, INC.

Table of content: CHI VU THAO PHAM DO (NPI 1629912597)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487734695 NPI number — PALOS VERDES AMBULATORY SURGERY CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PALOS VERDES AMBULATORY SURGERY CENTER, 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:
6
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:
1487734695
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11999 SAN VICENTE BLVD
Provider Second Line Business Mailing Address:
#440
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90049-5131
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-471-5852
Provider Business Mailing Address Fax Number:
310-471-3958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3400 LOMITA BLVD
Provider Second Line Business Practice Location Address:
STE. 307
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-4909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-539-5888
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PETTI
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-539-5888

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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