Healthcare Provider Details

I. General information

NPI: 1144256801
Provider Name (Legal Business Name): DIAMOND BAR SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1448 BRIDGEGATE DR
DIAMOND BAR CA
91765-3922
US

IV. Provider business mailing address

PO BOX 60790
PASADENA CA
91116-6790
US

V. Phone/Fax

Practice location:
  • Phone: 909-860-7767
  • Fax: 909-860-4191
Mailing address:
  • Phone: 909-860-7767
  • Fax: 909-860-4191

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. BRIAN SCOTT ADAMS
Title or Position: PRESIDENT
Credential: DENTIST
Phone: 909-860-7767