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General NPI Number Information
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NPI Number | 1265562045
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Entity Type | Organization
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Legal Business Name | MONTEBELLO SURGERY CENTER
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 229 E BEVERLY BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-3776
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Country | US
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Telephone | 323-728-5814
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Fax |
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Provider Business Mailing Address
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Address Line | 229 EAST BEVERLY BLVD.
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City | MONTEBELLO
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State | CA
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Zip | 90640
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Country | US
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Telephone | 323-728-5814
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. REGINALD SAMPSON
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Credential | M.D.
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Telephone | 323-728-5814
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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 |
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License Number State |
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