Healthcare Provider Details

I. General information

NPI: 1396130514
Provider Name (Legal Business Name): 15TH STREET SURGICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2015
Last Update Date: 04/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43821 15TH ST W
LANCASTER CA
93534-4756
US

IV. Provider business mailing address

43821 15TH ST W
LANCASTER CA
93534-4756
US

V. Phone/Fax

Practice location:
  • Phone: 661-379-8085
  • Fax: 661-368-9956
Mailing address:
  • Phone: 661-379-8085
  • Fax: 661-368-9956

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: DR. THUONG VO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 661-379-8085