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NPI Code Detail

MEDICARE: PACIFIC SURGICAL SUITE, LLC

MEDICARE: PACIFIC SURGICAL SUITE, LLC
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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1518452531
Entity Type Code : Organization
Provider Name (Legal Business Name) : PACIFIC SURGICAL SUITE, LLC
Provider Business Mailing Address
First Line : 558 SAINT CHARLES DR STE 200
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-3968
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 558 SAINT CHARLES DR STE 200
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-3968
Country : US
Telephone Number : 805-379-2322
Fax Number :
Authorized Official
Title or Position : BIILING MANAGER
Name : MONICA FANDINO
Credential :
Telephone Number : 805-379-2322
Provider Enumeration Date : 06/22/2018
Last Update Date : 09/26/2025

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Directions to “PACIFIC SURGICAL SUITE, LLC ” Practice Location

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