Healthcare Provider Details

I. General information

NPI: 1366408270
Provider Name (Legal Business Name): KERLAN-JOBE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 11/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 PARK TER STE 300
LOS ANGELES CA
90045-9212
US

IV. Provider business mailing address

6801 PARK TER SUITE 300
LOS ANGELES CA
90045-1543
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7200
  • Fax:
Mailing address:
  • Phone: 310-665-7150
  • 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: RALPH ANTHONY GAMBARDELLA
Title or Position: PARTNER
Credential: MD
Phone: 310-792-3914