Healthcare Provider Details

I. General information

NPI: 1649322405
Provider Name (Legal Business Name): INTERNATIONAL SURGICAL INSTITUTE,.A.M.C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 S LA CIENEGA BLVD STE 100
BEVERLY HILLS CA
90211-3321
US

IV. Provider business mailing address

PO BOX 108
BEVERLY HILLS CA
90213-0108
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-0086
  • Fax: 866-586-9678
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberC1985589
License Number StateCA

VIII. Authorized Official

Name: MAURA VENTURA
Title or Position: BILLER
Credential:
Phone: 310-975-1881