Healthcare Provider Details

I. General information

NPI: 1720359151
Provider Name (Legal Business Name): ST JOHN SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2012
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 S MOUNT VERNON AVE
COLTON CA
92324-4202
US

IV. Provider business mailing address

PO BOX 699
SAN DIMAS CA
91773-0699
US

V. Phone/Fax

Practice location:
  • Phone: 909-422-8015
  • Fax: 909-422-0625
Mailing address:
  • Phone: 909-971-9334
  • Fax: 909-575-3573

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: DR. JAMSHEED J SHAMLOO
Title or Position: OWNER
Credential: M.D.
Phone: 909-422-8015