Healthcare Provider Details

I. General information

NPI: 1902851009
Provider Name (Legal Business Name): 90210 SURGERY MEDICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 01/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9735 WILSHIRE BLVD SUITE 100
BEVERLY HILLS CA
90212-2107
US

IV. Provider business mailing address

3033 N 44TH ST STE 200
PHOENIX AZ
85018-7244
US

V. Phone/Fax

Practice location:
  • Phone: 310-601-3900
  • Fax: 310-601-3905
Mailing address:
  • Phone: 480-207-3737
  • Fax: 623-266-0053

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: MR. BRIAN GIESSLER
Title or Position: COO
Credential:
Phone: 480-207-3716