Healthcare Provider Details

I. General information

NPI: 1770740052
Provider Name (Legal Business Name): OAKPARK SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2008
Last Update Date: 05/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 S MARENGO AVE
PASADENA CA
91101-3130
US

IV. Provider business mailing address

2323 OAK PARK LN
SANTA BARBARA CA
93105-4276
US

V. Phone/Fax

Practice location:
  • Phone: 626-397-4910
  • Fax:
Mailing address:
  • Phone: 805-898-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HOWARD GROSS
Title or Position: PRESIDENT
Credential: MD
Phone: 805-898-2600