Healthcare Provider Details

I. General information

NPI: 1194968677
Provider Name (Legal Business Name): PROFESSIONAL SURGICENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 04/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4510 EXECUTIVE DR STE 105A
SAN DIEGO CA
92121-3022
US

IV. Provider business mailing address

4510 EXECUTIVE DR STE 105A
SAN DIEGO CA
92121-3022
US

V. Phone/Fax

Practice location:
  • Phone: 858-450-7694
  • Fax: 858-450-7690
Mailing address:
  • Phone: 858-450-7694
  • Fax: 858-450-7690

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. RALUAN GERARDO SOLTERO
Title or Position: CEO
Credential: M.D.
Phone: 858-450-7694