Healthcare Provider Details

I. General information

NPI: 1376558965
Provider Name (Legal Business Name): SPECIALTY SURGICAL CENTER OF BEVERLY HILLS LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 WILSHIRE BLVD STE 300
BEVERLY HILLS CA
90211-2930
US

IV. Provider business mailing address

8670 WILSHIRE BLVD STE 300
BEVERLY HILLS CA
90211-2930
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-1646
  • Fax:
Mailing address:
  • Phone: 310-275-1646
  • Fax:

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