Healthcare Provider Details

I. General information

NPI: 1548684533
Provider Name (Legal Business Name): SURGICAL MEDICAL CENTER ON ROXBURY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2014
Last Update Date: 02/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 N. ROXBURY DR. SUITE 405
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

435 N. ROXBURY DR. SUITE 405
BEVERLY HILLS CA
90210
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-2472
  • Fax: 310-275-2478
Mailing address:
  • Phone: 310-275-2472
  • Fax: 310-275-2478

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: MR. ALEXANDER SOROKURS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-622-5369