Healthcare Provider Details

I. General information

NPI: 1912369703
Provider Name (Legal Business Name): SELECT SURGICAL, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 09/15/2020
Certification Date: 09/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1223 WILSHIRE BLVD STE 594
SANTA MONICA CA
90403-5406
US

IV. Provider business mailing address

1223 WILSHIRE BLVD STE 594
SANTA MONICA CA
90403-5406
US

V. Phone/Fax

Practice location:
  • Phone: 213-935-8566
  • Fax:
Mailing address:
  • Phone: 213-935-8566
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JENNIFER HERTZ
Title or Position: PRESIDENT
Credential: MD
Phone: 323-445-6249