Healthcare Provider Details

I. General information

NPI: 1740371665
Provider Name (Legal Business Name): SUMMIT SURGICAL ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 05/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

416 N BEDFORD DR STE 400
BEVERLY HILLS CA
90210-4318
US

IV. Provider business mailing address

416 N BEDFORD DR STE 400
BEVERLY HILLS CA
90210-4318
US

V. Phone/Fax

Practice location:
  • Phone: 310-275-5566
  • Fax: 310-271-0521
Mailing address:
  • Phone: 310-275-5566
  • Fax: 310-271-0521

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: DEBBIE LEE KRAWCZYK
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-859-9988