Healthcare Provider Details

I. General information

NPI: 1982821708
Provider Name (Legal Business Name): WARDLOW SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 03/24/2008
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

660 HAMPSHIRE RD 200
WESTLAKE VILLAGE CA
91361-2504
US

V. Phone/Fax

Practice location:
  • Phone: 562-424-3574
  • Fax:
Mailing address:
  • Phone: 805-497-3736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ANDREE BUCKLEY
Title or Position: CFO
Credential:
Phone: 805-497-3736