Healthcare Provider Details

I. General information

NPI: 1922561042
Provider Name (Legal Business Name): SERRA MEDICAL AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2019
Last Update Date: 10/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 NEWBURY RD
THOUSAND OAKS CA
91320-3663
US

IV. Provider business mailing address

2545 W HILLCREST DR
THOUSAND OAKS CA
91320-2296
US

V. Phone/Fax

Practice location:
  • Phone: 805-367-7522
  • Fax:
Mailing address:
  • Phone: 805-367-7522
  • 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. ALEXANDER P HERSEL
Title or Position: OWNER
Credential: MD
Phone: 805-367-7522