MEDICARE: RANCHO SURGICAL INSTITUTE 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
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1528364569
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RANCHO SURGICAL INSTITUTE LLC

Provider Business Mailing Address
First Line	:	8916 SAN BERNARDINO RD
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-8801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8916 SAN BERNARDINO RD
Second Line	:
City	:	RANCHO CUCAMONGA
State	:	CA
Zip	:	91730-8801
Country	:	US
Telephone Number	:	310-975-1881
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL BILLER
Name	:	MAURA VENTURA
Credential	:
Telephone Number	:	310-975-1881

Provider Enumeration Date	:	02/09/2011
Last Update Date	:	02/09/2011

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