Healthcare Provider Details

I. General information

NPI: 1033102140
Provider Name (Legal Business Name): SSC HOLDINGS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 08/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81812 DR CARREON BLVD SUITE F
INDIO CA
92201
US

IV. Provider business mailing address

81812 DR CARREON BLVD SUITE F
INDIO CA
92201
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-2225
  • Fax: 760-775-2377
Mailing address:
  • Phone: 760-775-2225
  • Fax: 760-775-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number250000805
License Number StateCA

VIII. Authorized Official

Name: DAN BOWERS
Title or Position: PRESIDENT
Credential:
Phone: 760-775-8019