Healthcare Provider Details

I. General information

NPI: 1255436028
Provider Name (Legal Business Name): PASADENA SURGERY CENTER INC. A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 S FAIR OAKS AVE SUITE 101
PASADENA CA
91105-2699
US

IV. Provider business mailing address

10565 CIVIC CENTER DR STE 250
RANCHO CUCAMONGA CA
91730-3854
US

V. Phone/Fax

Practice location:
  • Phone: 626-403-6488
  • Fax: 626-403-6486
Mailing address:
  • Phone: 626-403-6488
  • Fax: 626-403-6486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number930000957
License Number StateCA

VIII. Authorized Official

Name: DR. CLAYTON ALEXANDER VARGA
Title or Position: CEO
Credential: M.D.
Phone: 626-696-1400