Healthcare Provider Details

I. General information

NPI: 1508144007
Provider Name (Legal Business Name): PACIFIC SPECIALIST SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 05/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 VAN NESS AVE #301
SAN FRANCISCO CA
94102-6041
US

IV. Provider business mailing address

77 VAN NESS AVE #301
SAN FRANCISCO CA
94102-6041
US

V. Phone/Fax

Practice location:
  • Phone: 415-821-8015
  • Fax: 415-379-9045
Mailing address:
  • Phone: 415-821-8015
  • Fax: 415-379-9045

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. EDWARD MIRANDA
Title or Position: MANAGER
Credential: MD
Phone: 415-379-9015