Healthcare Provider Details

I. General information

NPI: 1508163767
Provider Name (Legal Business Name): SPECIALTY SURGICAL INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2011
Last Update Date: 02/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 HAALAND DR STE 100
THOUSAND OAKS CA
91361-5229
US

IV. Provider business mailing address

425 HAALAND DR STE 102
THOUSAND OAKS CA
91361-5229
US

V. Phone/Fax

Practice location:
  • Phone: 805-777-3877
  • Fax:
Mailing address:
  • Phone: 805-777-3877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. GIL KRYGER
Title or Position: PRESIDENT
Credential: MD
Phone: 805-777-3877