Healthcare Provider Details

I. General information

NPI: 1174538748
Provider Name (Legal Business Name): SPECIALTY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 11/19/2025
Certification Date: 02/08/2023
Deactivation Date: 11/14/2025
Reactivation Date: 11/19/2025

III. Provider practice location address

9001 WILSHIRE BLVD SUITE 100
BEVERLY HILLS CA
90211-1840
US

IV. Provider business mailing address

9001 WILSHIRE BLVD SUITE 100
BEVERLY HILLS CA
90211-1840
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-2339
  • Fax: 310-275-2357
Mailing address:
  • Phone: 310-275-2339
  • Fax: 310-275-2357

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER B BALDOCK
Title or Position: OFFICER AND AUTHORIZED OFFICIAL
Credential:
Phone: 615-234-5954