Healthcare Provider Details

I. General information

NPI: 1942522628
Provider Name (Legal Business Name): INTEGRATED SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2010
Last Update Date: 02/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8670 WILSHIRE BLVD SUITE 203
BEVERLY HILLS CA
90211-2924
US

IV. Provider business mailing address

POST OFFICE BOX 269092
OKLAHOMA CITY OK
73126-9092
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-0752
  • Fax:
Mailing address:
  • Phone: 310-855-0752
  • Fax:

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: DR. JONATHAN NISSANOFF
Title or Position: CEO
Credential: M.D
Phone: 310-855-0752