Healthcare Provider Details

I. General information

NPI: 1932641420
Provider Name (Legal Business Name): AST SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2016
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE 200
BEVERLY HILLS CA
90212-1840
US

IV. Provider business mailing address

9675 BRIGHTON WAY STE B1
BEVERLY HILLS CA
90210-5144
US

V. Phone/Fax

Practice location:
  • Phone: 310-857-8528
  • Fax:
Mailing address:
  • Phone: 310-801-6741
  • Fax: 310-227-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA116163
License Number StateCA

VIII. Authorized Official

Name: DR. NEIL GHODADRA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-801-6741