Healthcare Provider Details

I. General information

NPI: 1710319017
Provider Name (Legal Business Name): PREMIERE SURGICAL SPECIALISTS, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2013
Last Update Date: 07/10/2022
Certification Date: 07/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 S ARROYO PKWY STE 310
PASADENA CA
91105-3930
US

IV. Provider business mailing address

35 E GLENARM ST
PASADENA CA
91105-3418
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-4859
  • Fax: 626-403-0311
Mailing address:
  • Phone: 626-449-4859
  • Fax: 626-403-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRIAN ALLEN COX
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-449-4859