Healthcare Provider Details
I. General information
NPI: 1700162054
Provider Name (Legal Business Name): SOLAR SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 11/01/2011
Last Update Date: 08/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1901 SOLAR DR SUITE 100
OXNARD CA
93036-2641
US
IV. Provider business mailing address
1901 SOLAR DR SUITE 100
OXNARD CA
93036-2641
US
V. Phone/Fax
- Phone: 805-485-4345
- Fax: 805-512-7161
- Phone: 805-485-4345
- Fax: 805-512-7161
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QA1903X |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
ANDREW
R
LANGROUDI
Title or Position: OWNER
Credential: D.P.M.
Phone: 805-485-4345