Healthcare Provider Details

I. General information

NPI: 1548651623
Provider Name (Legal Business Name): NORTHWEST SURGICAL DEVELOPMENT OF PASADENA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2015
Last Update Date: 02/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 E COLORADO BLVD STE 102
PASADENA CA
91105-1937
US

IV. Provider business mailing address

65 ENTERPRISE STE 125
ALISO VIEJO CA
92656-2706
US

V. Phone/Fax

Practice location:
  • Phone: 626-584-5898
  • Fax:
Mailing address:
  • Phone: 949-600-9931
  • Fax: 949-600-8029

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: MR. JAMES HAEFNER
Title or Position: ADMINISTRATION
Credential:
Phone: 949-600-9931