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General NPI Number Information
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NPI Number | 1366408270
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Entity Type | Organization
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Legal Business Name | KERLAN-JOBE SURGERY CENTER LLC
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Dates
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Enumeration Date | 04/21/2006
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Last Update Date | 11/09/2018
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Provider Practice Location Address
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Address Line | 6801 PARK TER STE 300
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City | LOS ANGELES
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State | CA
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Zip | 90045-9212
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Country | US
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Telephone | 310-665-7200
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Fax |
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Provider Business Mailing Address
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Address Line | 6801 PARK TER SUITE 300
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City | LOS ANGELES
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State | CA
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Zip | 90045-1543
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Country | US
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Telephone | 310-665-7150
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Fax |
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Authorized Official
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Title or Position | PARTNER
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Name | RALPH ANTHONY GAMBARDELLA
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Credential | MD
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Telephone | 310-792-3914
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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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