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General NPI Number Information
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NPI Number | 1639214778
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Entity Type | Organization
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Legal Business Name | UNITED SURGERY CENTER
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 12/06/2011
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Provider Practice Location Address
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Address Line | 128 S MONTEBELLO BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4730
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Country | US
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Telephone | 323-720-9204
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Fax | 323-720-9208
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Provider Business Mailing Address
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Address Line | 128 S MONTEBELLO BLVD
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City | MONTEBELLO
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State | CA
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Zip | 90640-4730
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Country | US
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Telephone | 323-720-9204
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Fax | 323-720-9208
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Authorized Official
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Title or Position | BILLING OFFICE MANAGER
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Name | MR. ALEXANDER YACOUB
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Credential |
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Telephone | 323-720-9204
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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 | 930000995
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License Number State | CA
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