Healthcare Provider Details

I. General information

NPI: 1407327356
Provider Name (Legal Business Name): ADVANCED SURGICAL CENTER OF BEVERLY HILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8750 WILSHIRE BLVD STE 150
BEVERLY HILLS CA
90211-2725
US

IV. Provider business mailing address

1871 MARTIN AVE
SANTA CLARA CA
95050-2501
US

V. Phone/Fax

Practice location:
  • Phone: 408-761-5847
  • Fax:
Mailing address:
  • Phone: 408-761-5847
  • Fax: 408-899-6155

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0005X
TaxonomyAmbulatory Family Planning Facility
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BARBARA LEE ROTH
Title or Position: VP OF CLINICAL OPERATIONS
Credential: REGISTERED NURSE
Phone: 408-761-5847