Healthcare Provider Details

I. General information

NPI: 1407960578
Provider Name (Legal Business Name): WILSHIRE SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 WILSHIRE BLVD SUITE 100
BEVERLY HILLS CA
90211-2713
US

IV. Provider business mailing address

1516 COTNER AVE
LOS ANGELES CA
90025-3303
US

V. Phone/Fax

Practice location:
  • Phone: 310-689-3100
  • Fax: 310-689-3130
Mailing address:
  • Phone: 310-445-2800
  • Fax: 310-445-2816

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. HOWARD G. BERGER
Title or Position: PRESIDENT
Credential: MD
Phone: 310-445-2800