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General NPI Number Information
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NPI Number | 1033102140
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Entity Type | Organization
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Legal Business Name | SSC HOLDINGS LLC
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Dates
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Enumeration Date | 08/24/2005
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Last Update Date | 08/26/2008
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Provider Practice Location Address
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Address Line | 81812 DR CARREON BLVD SUITE F
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City | INDIO
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State | CA
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Zip | 92201
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Country | US
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Telephone | 760-775-2225
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Fax | 760-775-2377
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Provider Business Mailing Address
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Address Line | 81812 DR CARREON BLVD SUITE F
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City | INDIO
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State | CA
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Zip | 92201
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Country | US
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Telephone | 760-775-2225
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Fax | 760-775-2377
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Authorized Official
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Title or Position | PRESIDENT
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Name | DAN BOWERS
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Credential |
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Telephone | 760-775-8019
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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 | 250000805
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License Number State | CA
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