Healthcare Provider Details

I. General information

NPI: 1013376482
Provider Name (Legal Business Name): TEMECULA CA UNITED SURGERY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2016
Last Update Date: 04/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31469 RANCHO PUEBLO RD SUITE 100
TEMECULA CA
92592-4834
US

IV. Provider business mailing address

1A BURTON HILLS BLVD
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 951-303-6890
  • Fax:
Mailing address:
  • Phone: 615-665-1283
  • Fax: 615-234-1720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. PHILLIP C CLENDENIN
Title or Position: PRESIDENT
Credential:
Phone: 615-240-3820