Healthcare Provider Details

I. General information

NPI: 1215344312
Provider Name (Legal Business Name): MONTEREY ASC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2014
Last Update Date: 07/21/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44139 MONTEREY AVE SUITE B
PALM DESERT CA
92260-8700
US

IV. Provider business mailing address

44139 MONTEREY AVE SUITE B
PALM DESERT CA
92260-8700
US

V. Phone/Fax

Practice location:
  • Phone: 949-610-0033
  • 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: TOM S. CHANG
Title or Position: OWNER
Credential: M.D.
Phone: 626-676-0838