Healthcare Provider Details

I. General information

NPI: 1891407425
Provider Name (Legal Business Name): PEDIATRIC SURGERY SOLUTIONS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2190 LYNN RD STE 200
THOUSAND OAKS CA
91360-8020
US

IV. Provider business mailing address

PO BOX 6287
MALIBU CA
90264-6287
US

V. Phone/Fax

Practice location:
  • Phone: 805-372-8500
  • Fax:
Mailing address:
  • Phone: 805-372-8500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: PHILIP FRYKMAN
Title or Position: OWNER
Credential: MD
Phone: 805-372-8500