Healthcare Provider Details

I. General information

NPI: 1316579055
Provider Name (Legal Business Name): NOVA AMBULATORY SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4542 LAS POSAS RD STE C
CAMARILLO CA
93010-2532
US

IV. Provider business mailing address

PO BOX 3129
TORRANCE CA
90510-3129
US

V. Phone/Fax

Practice location:
  • Phone: 805-585-5004
  • Fax: 805-484-3099
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-898-4055

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: ELIDA PETTYJOHN
Title or Position: CREDENTIALING ACCT MANAGER
Credential:
Phone: 512-454-5911