Healthcare Provider Details

I. General information

NPI: 1912322595
Provider Name (Legal Business Name): PREMIER SPECIALTY SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 02/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7230 MEDICAL CENTER DR SUITE 502-503
WEST HILLS CA
91307-1907
US

IV. Provider business mailing address

7230 MEDICAL CENTER DR SUITE 502-503
WEST HILLS CA
91307-1907
US

V. Phone/Fax

Practice location:
  • Phone: 818-348-6014
  • Fax: 818-348-7012
Mailing address:
  • Phone: 818-348-6014
  • Fax: 818-348-7012

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. PAUL BENNETT JOHNSON
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 818-348-6014