=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255436028
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PASADENA SURGERY CENTER INC. A MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2006
-----------------------------------------------------
Last Update Date | 03/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1035 S FAIR OAKS AVE SUITE 101
-----------------------------------------------------
City | PASADENA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91105-2699
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-403-6488
-----------------------------------------------------
Fax | 626-403-6486
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10565 CIVIC CENTER DR STE 250
-----------------------------------------------------
City | RANCHO CUCAMONGA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91730-3854
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 626-403-6488
-----------------------------------------------------
Fax | 626-403-6486
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | DR. CLAYTON ALEXANDER VARGA
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 626-696-1400
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number | 930000957
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------