Healthcare Provider Details

I. General information

NPI: 1114043858
Provider Name (Legal Business Name): AZUSA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S. CITRUS AVE SUITE 101
AZUSA CA
91702
US

IV. Provider business mailing address

10565 CIVIC CENTER DR STE 250
RANCHO CUCAMONGA CA
91730-3854
US

V. Phone/Fax

Practice location:
  • Phone: 626-543-1560
  • Fax:
Mailing address:
  • Phone: 626-543-1560
  • Fax: 626-974-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. CLAYTON A VARGA
Title or Position: CEO
Credential: M.D
Phone: 626-696-1400