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General NPI Number Information
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NPI Number | 1285068536
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Entity Type | Organization
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Legal Business Name | EYE SURGERY CENTER OF SOUTHERN CALIFORNIA, A MEDICAL GROUP
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Dates
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Enumeration Date | 08/22/2013
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Last Update Date | 08/26/2013
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Provider Practice Location Address
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Address Line | 2023 W VISTA WAY SUITE E
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City | VISTA
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State | CA
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Zip | 92083-6030
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Country | US
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Telephone | 760-941-8152
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Fax |
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Provider Business Mailing Address
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Address Line | 2980 N BEVERLY GLEN CIR SUITE 301
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City | LOS ANGELES
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State | CA
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Zip | 90077-1726
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Country | US
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Telephone | 310-943-4180
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. ANUJ GUPTA
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Credential | M.D.
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Telephone | 760-941-8152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number | A85939
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License Number State | CA
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