Healthcare Provider Details

I. General information

NPI: 1356356133
Provider Name (Legal Business Name): INLAND VALLEY SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 07/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 POMERADO RD., SUITE E6
POWAY CA
92064
US

IV. Provider business mailing address

PO BOX 502530
SAN DIEGO CA
92150-2530
US

V. Phone/Fax

Practice location:
  • Phone: 858-451-2280
  • Fax: 858-451-2006
Mailing address:
  • Phone: 858-451-2280
  • Fax: 858-451-2006

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: JONATHAN NISSANOFF
Title or Position: CEO/OWNER
Credential: MD
Phone: 858-451-2280