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General NPI Number Information
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NPI Number | 1386186781
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Entity Type | Organization
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Legal Business Name | BUENA VISTA SURGERY CENTER, LLC
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Dates
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Enumeration Date | 11/16/2016
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 1762 MANHATTAN BEACH BLVD STE 202
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-6220
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Country | US
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Telephone | 888-282-7472
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Fax |
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Provider Business Mailing Address
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Address Line | 121 GRAY AVE SUITE 200
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City | SANTA BARBARA
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State | CA
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Zip | 93101-1800
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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 | OWNER
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Name | MATTHEW ENNA
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Credential |
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Telephone | 310-858-3880
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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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