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General NPI Number Information
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NPI Number | 1336753649
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Entity Type | Organization
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Legal Business Name | POMONA VALLEY SPECIALTY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 09/03/2020
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Last Update Date | 09/03/2020
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Provider Practice Location Address
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Address Line | 1980 N ORANGE GROVE AVE
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City | POMONA
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State | CA
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Zip | 91767-3008
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Country | US
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Telephone | 800-208-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 269 S BEVERLY DR # 1409
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-3851
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DR. LEE AU
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Credential | MD
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Telephone | 800-208-7000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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