Healthcare Provider Details

I. General information

NPI: 1891721494
Provider Name (Legal Business Name): VALENCIA SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 11/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9001 WILSHIRE BLVD SUITE 106
BEVERLY HILLS CA
90211-1838
US

IV. Provider business mailing address

9001 WILSHIRE BLVD SUITE 106
BEVERLY HILLS CA
90211-1838
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-8885
  • Fax: 310-273-8662
Mailing address:
  • Phone: 310-273-8885
  • Fax: 310-273-8662

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: MR. THOMAS C CLOUD III
Title or Position: CONSULTANT
Credential: MPH
Phone: 310-273-8885