Healthcare Provider Details

I. General information

NPI: 1922052141
Provider Name (Legal Business Name): SOUTHERN CALIFORNIA NEUROSURGICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/20/2006
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 FAIR OAKS AVE STE 175
SOUTH PASADENA CA
91030-2683
US

IV. Provider business mailing address

625 FAIR OAKS AVE STE 175
SOUTH PASADENA CA
91030-2683
US

V. Phone/Fax

Practice location:
  • Phone: 626-793-8194
  • Fax: 626-793-3664
Mailing address:
  • Phone: 626-793-8194
  • Fax: 626-793-3664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. IAN ROSS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 626-793-8194