Healthcare Provider Details

I. General information

NPI: 1063213700
Provider Name (Legal Business Name): INLAND PACIFIC SURGICAL PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 05/07/2025
Certification Date: 05/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15942 COLORADO AVE
PARAMOUNT CA
90723-5008
US

IV. Provider business mailing address

15942 COLORADO AVE
PARAMOUNT CA
90723-5008
US

V. Phone/Fax

Practice location:
  • Phone: 323-545-9288
  • Fax:
Mailing address:
  • Phone: 323-545-9288
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: OLIVIER URAYENEZA
Title or Position: PRESIDENT&CEO
Credential: MD
Phone: 323-545-9288