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General NPI Number Information
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NPI Number | 1114870227
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Entity Type | Organization
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Legal Business Name | ESSE CARE SURGERY CALIFORNIA PC
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Dates
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Enumeration Date | 02/18/2026
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Last Update Date | 02/18/2026
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Provider Practice Location Address
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Address Line | 4640 ADMIRALTY WAY
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City | MARINA DEL REY
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State | CA
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Zip | 90292-6621
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Country | US
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Telephone | 914-546-3461
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Fax | 646-846-2310
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Provider Business Mailing Address
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Address Line | 204 CORLIES AVE
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City | PELHAM
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State | NY
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Zip | 10803-1904
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Country | US
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Telephone | 914-546-3461
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Fax | 646-846-2310
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Authorized Official
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Title or Position | VP
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Name | BRANDON PROVOST
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Credential |
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Telephone | 914-546-3461
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number |
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License Number State |
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