Healthcare Provider Details

I. General information

NPI: 1518177534
Provider Name (Legal Business Name): HERNIA CENTER OF SOUTHERN CALIFORNIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31 WEST BELLEVUE DRIVE
PASADENA CA
91105
US

IV. Provider business mailing address

31 WEST BELLEVUE DRIVE
PASADENA CA
91105
US

V. Phone/Fax

Practice location:
  • Phone: 626-584-6116
  • Fax: 626-584-7886
Mailing address:
  • Phone: 626-584-6116
  • Fax: 626-584-7886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA39342
License Number StateCA

VIII. Authorized Official

Name: DR. DAVID MARK ALBIN
Title or Position: CEO, HERNIA CENTER OF SOUTHERN CALI
Credential: M.D.
Phone: 626-584-6116