MEDICARE: CYPRESS AMBULATORY SURGERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1235132481
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESS AMBULATORY SURGERY CENTER

Provider Business Mailing Address
First Line	:	PO BOX 5435
Second Line	:
City	:	SAN LUIS OBISPO
State	:	CA
Zip	:	93403-5435
Country	:	US
Telephone Number	:	805-782-8132
Fax Number	:	805-597-8350

Provider Business Practice Location Address
First Line	:	1300 E CYPRESS ST
Second Line	:	STE E1
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-4736
Country	:	US
Telephone Number	:	805-782-8132
Fax Number	:	805-597-8350

Authorized Official
Title or Position	:	MANAGER
Name	:	MISS INNA GRIBANOVA
Credential	:
Telephone Number	:	805-782-8132

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	10/25/2007

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