Healthcare Provider Details

I. General information

NPI: 1447420054
Provider Name (Legal Business Name): MISSION VALLEY OUTPATIENT SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/11/2008
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2878 CAMINO DEL RIO SOUTH 215
SD CA
92108
US

IV. Provider business mailing address

2878 CAMINO DEL RIO SOUTH 210
SD CA
92108
US

V. Phone/Fax

Practice location:
  • Phone: 619-298-2200
  • Fax: 619-298-2250
Mailing address:
  • Phone: 619-298-2200
  • Fax: 619-298-2250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number31922
License Number StateCA

VIII. Authorized Official

Name: DR. FREDERICK WHITE HAMMOND
Title or Position: OWNER
Credential: DDS
Phone: 619-298-2200