Healthcare Provider Details

I. General information

NPI: 1427487982
Provider Name (Legal Business Name): SAMARITAN TOWER SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2013
Last Update Date: 11/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 WILSHIRE BLVD SUITE 1000
LOS ANGELES CA
90017-3901
US

IV. Provider business mailing address

1127 WILSHIRE BLVD SUITE 1000
LOS ANGELES CA
90017-3901
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-1077
  • Fax: 213-977-1073
Mailing address:
  • Phone: 213-977-1077
  • Fax: 213-977-1073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP1100X
TaxonomyPodiatric Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JORGE DAMIAN MINOR
Title or Position: CEO
Credential: M.D
Phone: 213-977-1077