Healthcare Provider Details

I. General information

NPI: 1871939082
Provider Name (Legal Business Name): RAYMOND RENAISSANCE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 N RAYMOND AVE SUITE 212
PASADENA CA
91105-4535
US

IV. Provider business mailing address

7447 N FIGUEROA ST SUITE 200
LOS ANGELES CA
90041
US

V. Phone/Fax

Practice location:
  • Phone: 626-529-3937
  • Fax: 626-529-3844
Mailing address:
  • Phone: 626-529-3937
  • Fax: 626-529-3844

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. KHALED TAWANSY
Title or Position: OWNER
Credential: M.D
Phone: 323-257-3300