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General NPI Number Information
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NPI Number | 1407035215
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Entity Type | Organization
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Legal Business Name | BUENA VISTA SURGERY CENTER MEDICAL GROUP INC
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Dates
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Enumeration Date | 10/29/2007
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Last Update Date | 09/22/2014
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Provider Practice Location Address
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Address Line | 2701 W. ALAMEDA AVENUE SUITE 401B
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City | BURBANK
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State | CA
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Zip | 91505-4409
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Country | US
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Telephone | 805-823-6688
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Fax | 805-617-1743
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Provider Business Mailing Address
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Address Line | 121 GRAY AVENUE 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 | 888-282-7472
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Fax | 805-563-5410
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DAVE W ODELL
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Credential |
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Telephone | 805-679-7560
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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 | CA
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