Healthcare Provider Details

I. General information

NPI: 1831496231
Provider Name (Legal Business Name): ANTELOPE VALLEY SURGERY CENTER, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2011
Last Update Date: 08/07/2020
Certification Date: 08/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 W AVENUE Q SUITE C
PALMDALE CA
93551-3892
US

IV. Provider business mailing address

PO BOX 16297
BEVERLY HILLS CA
90209-2297
US

V. Phone/Fax

Practice location:
  • Phone: 800-991-6448
  • Fax: 424-369-9555
Mailing address:
  • Phone: 800-991-6448
  • 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: DR. DANIEL TAHERI
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 661-266-2994