Healthcare Provider Details

I. General information

NPI: 1346688355
Provider Name (Legal Business Name): RPH SURGERY CENTER CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2013
Last Update Date: 11/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

465 N ROXBURY DR PENTHOUSE SUITE
BEVERLY HILLS CA
90210-4206
US

IV. Provider business mailing address

465 N ROXBURY DR PENTHOUSE SUITE
BEVERLY HILLS CA
90210-4206
US

V. Phone/Fax

Practice location:
  • Phone: 310-770-9949
  • Fax: 310-388-1440
Mailing address:
  • Phone: 310-770-9949
  • Fax: 310-388-1440

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. JOHN DIAZ
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-770-9949