Healthcare Provider Details

I. General information

NPI: 1508416454
Provider Name (Legal Business Name): AVANT SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2019
Last Update Date: 09/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9301 WILSHIRE BLVD STE 100
BEVERLY HILLS CA
90210-6100
US

IV. Provider business mailing address

PO BOX 11508
BEVERLY HILLS CA
90213-5508
US

V. Phone/Fax

Practice location:
  • Phone: 310-855-3960
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ELAINE HSU
Title or Position: MANAGER
Credential:
Phone: 310-855-3960