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General NPI Number Information
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NPI Number | 1417468828
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Entity Type | Organization
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Legal Business Name | RANCHO OUTPATIENT SURGICAL CENTER, LLC.
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Dates
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Enumeration Date | 10/12/2017
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Last Update Date | 05/18/2020
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Provider Practice Location Address
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Address Line | 9461 PITTSBURGH AVE STE B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-9022
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Country | US
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Telephone | 909-638-1573
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Fax |
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Provider Business Mailing Address
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Address Line | 9461 PITTSBURGH AVE STE B
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-9022
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Country | US
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Telephone | 909-638-1573
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Fax |
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Authorized Official
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Title or Position | PRESIDENT / OWNER
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Name | JAMES NASSIRI
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Credential | MD
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Telephone | 909-638-1573
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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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