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General NPI Number Information
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NPI Number | 1023305984
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Entity Type | Organization
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Legal Business Name | LASER & AMBULATORY SURG CTR OF PASA
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Dates
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Enumeration Date | 06/29/2011
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Last Update Date | 05/12/2015
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Provider Practice Location Address
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Address Line | 800 E. COLORADO BLVD. SUITE 260
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City | PASADENA
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State | CA
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Zip | 91101
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Country | US
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Telephone | 626-449-6494
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Fax | 626-449-0813
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Provider Business Mailing Address
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Address Line | 800 E. COLORADO BLVD. SUITE 260
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City | PASADENA
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State | CA
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Zip | 91101
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Country | US
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Telephone | 626-449-6494
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Fax | 626-449-0813
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Authorized Official
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Title or Position | MD PRESIDENT
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Name | WARREN STOUT
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Credential | MD
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Telephone | 626-449-6494
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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