Healthcare Provider Details

I. General information

NPI: 1033686951
Provider Name (Legal Business Name): XCELL SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2018
Last Update Date: 10/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W WARDLOW RD
LONG BEACH CA
90807-4429
US

IV. Provider business mailing address

8929 WILSHIRE BLVD STE 200
BEVERLY HILLS CA
90211-1951
US

V. Phone/Fax

Practice location:
  • Phone: 562-276-0026
  • Fax:
Mailing address:
  • Phone: 310-897-0802
  • Fax:

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: NICHOLAS FULLER
Title or Position: PARTNER
Credential: MD
Phone: 310-897-0802