Healthcare Provider Details

I. General information

NPI: 1073705992
Provider Name (Legal Business Name): LAS VEGAS REGIONAL SURGERY CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3560 E FLAMINGO RD
LAS VEGAS NV
89121-5044
US

IV. Provider business mailing address

4333 ADMIRALTY WAY WEST HELIX #9
MARINA DEL REY CA
90292-5469
US

V. Phone/Fax

Practice location:
  • Phone: 702-454-8712
  • Fax:
Mailing address:
  • Phone: 310-301-8329
  • Fax: 310-301-8329

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number468ASC-15
License Number StateNV

VIII. Authorized Official

Name: DR. ISSAC VERBUKH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-301-8329