Healthcare Provider Details

I. General information

NPI: 1356878052
Provider Name (Legal Business Name): PAVILION SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2017
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1140 W LA VETA AVE
ORANGE CA
92868-4225
US

IV. Provider business mailing address

3033 N 44TH ST STE 200
PHOENIX AZ
85018-7244
US

V. Phone/Fax

Practice location:
  • Phone: 714-744-8711
  • Fax:
Mailing address:
  • Phone:
  • 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: BRIAN GIESSLER
Title or Position: SR VP OF ASC OPS & BUSINESS SVCS
Credential:
Phone: 480-207-3716