Healthcare Provider Details

I. General information

NPI: 1275015414
Provider Name (Legal Business Name): INTEGRITY SSURGICAL CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2018
Last Update Date: 09/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 N SAN DIMAS AVE # 201
SAN DIMAS CA
91773-2664
US

IV. Provider business mailing address

221 N SAN DIMAS AVE # 201
SAN DIMAS CA
91773-2664
US

V. Phone/Fax

Practice location:
  • Phone: 909-592-0142
  • Fax: 909-592-0339
Mailing address:
  • Phone: 909-592-0142
  • Fax: 909-592-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ALEXANDER SOROKURS
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 310-622-5369