Healthcare Provider Details

I. General information

NPI: 1538530324
Provider Name (Legal Business Name): PARAMOUNT SURGERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2015
Last Update Date: 02/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15942 COLORADO AVE
PARAMOUNT CA
90723-5008
US

IV. Provider business mailing address

8939 S SEPULVEDA BLVD SUITE 406
LOS ANGELES CA
90045-3631
US

V. Phone/Fax

Practice location:
  • Phone: 310-678-6672
  • Fax: 310-693-9840
Mailing address:
  • Phone: 310-678-6672
  • Fax: 310-693-9840

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: GUDATA HINIKA
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 310-678-6672