Healthcare Provider Details

I. General information

NPI: 1013512680
Provider Name (Legal Business Name): PCS SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2020
Last Update Date: 12/02/2020
Certification Date: 11/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PCS SURGERY CENTER 542 S FAIR OAKS AVE
PASADENA CA
91105
US

IV. Provider business mailing address

542 S FAIR OAKS AVE
PASADENA CA
91105-2606
US

V. Phone/Fax

Practice location:
  • Phone: 626-449-8910
  • Fax: 626-449-2155
Mailing address:
  • Phone: 626-449-8910
  • Fax: 626-449-2155

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: MARTIN O'TOOLE
Title or Position: PRESIDENT
Credential: MD
Phone: 626-449-8910