Healthcare Provider Details

I. General information

NPI: 1114103587
Provider Name (Legal Business Name): MERIT SURGERY CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2008
Last Update Date: 01/29/2024
Certification Date: 01/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 E FOOTHILL BLVD
UPLAND CA
91786-4034
US

IV. Provider business mailing address

843 E FOOTHILL BLVD
UPLAND CA
91786-4034
US

V. Phone/Fax

Practice location:
  • Phone: 909-982-1002
  • Fax:
Mailing address:
  • Phone: 909-982-1002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number05C0001814
License Number StateCA

VIII. Authorized Official

Name: ALI HEIDARI
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 909-982-1002