Healthcare Provider Details

I. General information

NPI: 1548330954
Provider Name (Legal Business Name): SURGICAL SUITE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 CALIFORNIA ST #500
SAN FRANCISCO CA
94109-4586
US

IV. Provider business mailing address

11999 SAN VICENTE BLVD #440
LOS ANGELES CA
90049-5131
US

V. Phone/Fax

Practice location:
  • Phone: 415-567-1791
  • Fax:
Mailing address:
  • Phone: 310-471-5852
  • Fax: 310-471-3958

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. FRED SUESS
Title or Position: OWNER
Credential: M.D.
Phone: 415-567-1791