Healthcare Provider Details

I. General information

NPI: 1932106358
Provider Name (Legal Business Name): THE CENTER FOR AMBULATORY SURGICAL TREATMENT, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 09/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1090 GLENDON AVE
LOS ANGELES CA
90024-2908
US

IV. Provider business mailing address

1090 GLENDON AVE
LOS ANGELES CA
90024-2908
US

V. Phone/Fax

Practice location:
  • Phone: 310-209-6500
  • Fax: 310-209-6225
Mailing address:
  • Phone: 310-209-6500
  • Fax: 310-209-6225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number930000985
License Number StateCA

VIII. Authorized Official

Name: KATHERINE L. REED
Title or Position: OFFICER, AUTHORIZED OFFICIAL
Credential:
Phone: 972-763-3859