Healthcare Provider Details

I. General information

NPI: 1679624233
Provider Name (Legal Business Name): IMAGEBASED SURGICENTER CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2716 OCEAN PARK BLVD SUITE 1007
SANTA MONICA CA
90405-5207
US

IV. Provider business mailing address

2716 OCEAN PARK BLVD SUITE 1007
SANTA MONICA CA
90405-5207
US

V. Phone/Fax

Practice location:
  • Phone: 310-314-6410
  • Fax: 310-314-2414
Mailing address:
  • Phone: 310-314-6410
  • Fax: 310-314-2414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number0000694940-AAAHC
License Number StateCA

VIII. Authorized Official

Name: DR. AARON GERSHON FILLER
Title or Position: MEDICAL DIRECTOR
Credential: M.D. PH.D.
Phone: 310-314-6410