1902858012 NPI number — NORTH PENINSULA SURGICAL CENTER LP

Table of content: DR. HUGH CHRISTOPHER MOORE M.D. (NPI 1033139001)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902858012 NPI number — NORTH PENINSULA SURGICAL CENTER LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH PENINSULA SURGICAL 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:
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:
1902858012
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 N. BRAND BLVD, STE 303
Provider Second Line Business Mailing Address:
PRIME MSO/NORTH PENINSULA SURGICAL CENTER
Provider Business Mailing Address City Name:
GLENDALE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-937-9969
Provider Business Mailing Address Fax Number:
818-937-9968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
22525 MAPLE AVE
Provider Second Line Business Practice Location Address:
STE 101
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90505-2700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-602-5480
Provider Business Practice Location Address Fax Number:
858-225-0292
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TCHAMANIAN
Authorized Official First Name:
CAROLINE
Authorized Official Middle Name:
NICOLE
Authorized Official Title or Position:
C.O.O.
Authorized Official Telephone Number:
818-937-9969

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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