Healthcare Provider Details

I. General information

NPI: 1518007608
Provider Name (Legal Business Name): ROXBURY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 N ROXBURY DR FL 5
BEVERLY HILLS CA
90210-4226
US

IV. Provider business mailing address

450 N ROXBURY DR FL 5
BEVERLY HILLS CA
90210-4226
US

V. Phone/Fax

Practice location:
  • Phone: 310-246-4628
  • Fax: 310-859-4886
Mailing address:
  • Phone: 310-246-4628
  • Fax: 310-859-4886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number2029
License Number StateCA

VIII. Authorized Official

Name: MARK SURREY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-246-4628