Healthcare Provider Details

I. General information

NPI: 1134739147
Provider Name (Legal Business Name): PASADENA AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S FAIR OAKS AVE STE 106
PASADENA CA
91105-2536
US

IV. Provider business mailing address

301 S FAIR OAKS AVE STE 106
PASADENA CA
91105-2536
US

V. Phone/Fax

Practice location:
  • Phone: 626-440-0099
  • Fax: 626-440-0099
Mailing address:
  • Phone: 626-440-0099
  • Fax: 626-440-1002

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: DR. HUSAM ELIAS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 626-440-0066