Healthcare Provider Details

I. General information

NPI: 1306752084
Provider Name (Legal Business Name): PLATINUM SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2026
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

440 N MOUNTAIN AVE STE 220
UPLAND CA
91786-5183
US

IV. Provider business mailing address

440 N MOUNTAIN AVE STE 220
UPLAND CA
91786-5183
US

V. Phone/Fax

Practice location:
  • Phone: 909-655-0300
  • Fax:
Mailing address:
  • Phone:
  • 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: HUSSEIN ABIDALI
Title or Position: PRESIDENT
Credential: MD
Phone: 480-251-5887