Healthcare Provider Details

I. General information

NPI: 1639613128
Provider Name (Legal Business Name): SURGERY CENTERS OF IMPERIAL VALLEY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2016
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2402 BUSINESS PARKWAY SUITE 101
IMPERIAL CA
92251
US

IV. Provider business mailing address

2402 BUSINESS PARKWAY SUITE 101
IMPERIAL CA
92251
US

V. Phone/Fax

Practice location:
  • Phone: 760-351-8669
  • Fax: 760-351-8994
Mailing address:
  • Phone: 760-351-8669
  • Fax: 760-351-8994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA101939
License Number StateCA

VIII. Authorized Official

Name: DR. SAYED MONIS
Title or Position: CEO
Credential:
Phone: 760-351-8669