Healthcare Provider Details

I. General information

NPI: 1164848032
Provider Name (Legal Business Name): LIBERTY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2014
Last Update Date: 03/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MOWRY AVE SUITE 401
FREMONT CA
94538-1730
US

IV. Provider business mailing address

9461 CHARLEVILLE BLVD SUITE 483
BEVERLY HILLS CA
90212-3017
US

V. Phone/Fax

Practice location:
  • Phone: 510-713-0700
  • Fax: 510-713-0701
Mailing address:
  • Phone: 424-279-9481
  • Fax: 424-279-9482

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: MS. MAUREEN JAROSCAK
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 424-279-9481