MEDICARE: CLINICAL SOLUTIONS ASC LL

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	:	1639836505
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLINICAL SOLUTIONS ASC LL

Provider Business Mailing Address
First Line	:	4215 HAMILTON AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95130-1462
Country	:	US
Telephone Number	:	408-761-5847
Fax Number	:

Provider Business Practice Location Address
First Line	:	2529 CHARLEVILLE AVE UNIT 103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89106-1525
Country	:	US
Telephone Number	:	408-761-5847
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. BARBARA LEE ROTH
Credential	:	REGISTERED NURSE
Telephone Number	:	408-761-5847

Provider Enumeration Date	:	11/26/2021
Last Update Date	:	11/26/2021

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