Healthcare Provider Details

I. General information

NPI: 1073999033
Provider Name (Legal Business Name): CANON SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2015
Last Update Date: 07/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9400 BRIGHTON WAY SUITE 405
BEVERLY HILLS CA
90210-4714
US

IV. Provider business mailing address

9400 BRIGHTON WAY SUITE 405
BEVERLY HILLS CA
90210-4714
US

V. Phone/Fax

Practice location:
  • Phone: 310-276-4494
  • Fax: 310-276-8988
Mailing address:
  • Phone: 310-276-4494
  • Fax: 310-276-8988

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. ANDRE BERGER
Title or Position: MANAGING MEMBER
Credential: M.D.
Phone: 310-276-4494