Healthcare Provider Details

I. General information

NPI: 1568529337
Provider Name (Legal Business Name): PALDALE AMBULATORY SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1529 E PALMDALE BLVD SUITE 207
PALMDALE CA
93550-2034
US

IV. Provider business mailing address

9001 WILSHIRE BLVD SUITE 106
BEVERLY HILLS CA
90211-1838
US

V. Phone/Fax

Practice location:
  • Phone: 661-267-1900
  • Fax: 661-267-0700
Mailing address:
  • Phone: 310-273-8885
  • Fax: 310-273-8662

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. THOMAS C CLOUD III
Title or Position: CONSULTANT
Credential: MPH
Phone: 310-308-9678