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General NPI Number Information
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NPI Number | 1194028233
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Entity Type | Organization
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Legal Business Name | PAVILLION ASC INC.
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Dates
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Enumeration Date | 12/13/2010
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Last Update Date | 12/13/2010
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Provider Practice Location Address
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Address Line | 28901 S. WESTERN AVENUE #127
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City | RANCHO PALOS VEREDES
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State | CA
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Zip | 90275
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Country | US
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Telephone | 310-514-2511
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Fax | 310-514-2449
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Provider Business Mailing Address
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Address Line | P.O. BOX 9225
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City | CALABASAS
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State | CA
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Zip | 91372
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Country | US
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Telephone | 310-514-2511
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Fax | 310-514-2449
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | HOSSEIN A NAJAFI
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Credential | M.D.
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Telephone | 310-514-2511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ND0900X
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Taxonomy Name | Dermatopathology Physician
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License Number | A37763
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | A37763
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number | A37763
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License Number State | CA
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