Healthcare Provider Details

I. General information

NPI: 1285738682
Provider Name (Legal Business Name): NOVA SURGICENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2006
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 S SPALDING DR STE. 205
BEVERLY HILLS CA
90212-1800
US

IV. Provider business mailing address

120 S SPALDING DR SUITE 205
BEVERLY HILLS CA
90212-1800
US

V. Phone/Fax

Practice location:
  • Phone: 310-273-8002
  • Fax: 310-273-8608
Mailing address:
  • Phone: 310-273-8002
  • Fax: 310-273-8608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberS551088
License Number StateCA

VIII. Authorized Official

Name: KRISTI M. FUNK
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-273-8002