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General NPI Number Information
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NPI Number | 1356356133
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Entity Type | Organization
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Legal Business Name | INLAND VALLEY SURGICAL CENTER
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Dates
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Enumeration Date | 07/30/2006
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Last Update Date | 07/24/2008
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Provider Practice Location Address
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Address Line | 15525 POMERADO RD., SUITE E6
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City | POWAY
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State | CA
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Zip | 92064
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Country | US
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Telephone | 858-451-2280
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Fax | 858-451-2006
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Provider Business Mailing Address
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Address Line | PO BOX 502530
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City | SAN DIEGO
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State | CA
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Zip | 92150-2530
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Country | US
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Telephone | 858-451-2280
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Fax | 858-451-2006
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Authorized Official
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Title or Position | CEO/OWNER
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Name | JONATHAN NISSANOFF
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Credential | MD
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Telephone | 858-451-2280
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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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