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General NPI Number Information
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NPI Number | 1447420054
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Entity Type | Organization
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Legal Business Name | MISSION VALLEY OUTPATIENT SURGERY CENTER
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Dates
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Enumeration Date | 03/11/2008
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Last Update Date | 04/21/2011
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Provider Practice Location Address
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Address Line | 2878 CAMINO DEL RIO SOUTH 215
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City | SD
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State | CA
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Zip | 92108
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Country | US
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Telephone | 619-298-2200
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Fax | 619-298-2250
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Provider Business Mailing Address
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Address Line | 2878 CAMINO DEL RIO SOUTH 210
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City | SD
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State | CA
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Zip | 92108
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Country | US
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Telephone | 619-298-2200
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Fax | 619-298-2250
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Authorized Official
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Title or Position | OWNER
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Name | DR. FREDERICK WHITE HAMMOND
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Credential | DDS
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Telephone | 619-298-2200
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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 | 31922
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License Number State | CA
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