Healthcare Provider Details

I. General information

NPI: 1083944375
Provider Name (Legal Business Name): OBSERVATORY SURGERY CENTER LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2010
Last Update Date: 01/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

271 OBSERVATORY AVE
UKIAH CA
95482-5757
US

IV. Provider business mailing address

271 OBSERVATORY AVE
UKIAH CA
95482-5757
US

V. Phone/Fax

Practice location:
  • Phone: 707-462-2299
  • Fax: 707-462-1194
Mailing address:
  • Phone: 707-462-2299
  • Fax: 707-462-1194

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: MR. HARRY B MATOSSIAN
Title or Position: MD/ OWNER
Credential: MD
Phone: 707-462-0681