Healthcare Provider Details

I. General information

NPI: 1194526665
Provider Name (Legal Business Name): PACIFIC INNOVATIVE SURGERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2025
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 BROOKSHIRE AVE STE 301B
DOWNEY CA
90241-5026
US

IV. Provider business mailing address

PO BOX 379
PASADENA CA
91102-0379
US

V. Phone/Fax

Practice location:
  • Phone: 562-548-7530
  • Fax:
Mailing address:
  • Phone: 401-575-0308
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. MALWINDER SINGHA
Title or Position: PRESIDENT
Credential: MD
Phone: 401-575-0308