Healthcare Provider Details

I. General information

NPI: 1811095136
Provider Name (Legal Business Name): GROSSMONT OUTPATIENT SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DRIVE BLDG. 3 SUITE 250
LA MESA CA
91942-3026
US

IV. Provider business mailing address

5565 GROSSMONT CENTER DRIVE BLDG. 3 SUITE 250
LA MESA CA
91942-3026
US

V. Phone/Fax

Practice location:
  • Phone: 619-462-8620
  • Fax: 619-462-8621
Mailing address:
  • Phone: 619-462-8620
  • Fax: 619-462-8621

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: ROSE M ELLIS
Title or Position: ADMINISTRATOR
Credential: RN
Phone: 619-462-8620