Healthcare Provider Details

I. General information

NPI: 1124395876
Provider Name (Legal Business Name): RISSER SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2011
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

IV. Provider business mailing address

2615 E WASHINGTON BLVD
PASADENA CA
91107-1412
US

V. Phone/Fax

Practice location:
  • Phone: 626-269-2601
  • Fax:
Mailing address:
  • Phone: 626-269-2601
  • 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: ANDREW BALL
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 310-651-2050