Healthcare Provider Details

I. General information

NPI: 1861408643
Provider Name (Legal Business Name): SPECIALTY SURGICAL CENTER OF ARCADIA LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N 5TH AVE STE. 101
ARCADIA CA
91006-3710
US

IV. Provider business mailing address

51 N 5TH AVE STE. 101
ARCADIA CA
91006-3710
US

V. Phone/Fax

Practice location:
  • Phone: 626-471-9901
  • Fax: 626-471-9020
Mailing address:
  • Phone: 626-471-9901
  • Fax: 626-471-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. ERIC WOLD
Title or Position: MANAGER
Credential:
Phone: 626-471-9901