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General NPI Number Information
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NPI Number | 1093891004
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Entity Type | Organization
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Legal Business Name | SUNSET SURGICAL CENTER A MEDICAL CORPORATION
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 222 N SUNSET AVE STE A
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City | WEST COVINA
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State | CA
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Zip | 91790-2278
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Country | US
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Telephone | 626-338-4545
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Fax | 626-869-0387
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Provider Business Mailing Address
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Address Line | 222 N SUNSET AVE STE A
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City | WEST COVINA
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State | CA
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Zip | 91790-2278
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Country | US
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Telephone | 626-338-4545
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Fax | 626-869-0387
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Authorized Official
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Title or Position | BILLER/OFFICE MANAGER
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Name | AMANDA LOERA
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Credential |
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Telephone | 626-338-4545
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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 | BUSINESS LICENS08034
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License Number State | CA
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