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General NPI Number Information
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NPI Number | 1669569018
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Entity Type | Organization
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Legal Business Name | BRENTWOOD SURGERY CENTER INC.
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 11819 WILSHIRE BLVD STE 215
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City | LOS ANGELES
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State | CA
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Zip | 90025-6631
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Country | US
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Telephone | 310-444-8808
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Fax | 310-444-8809
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Provider Business Mailing Address
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Address Line | 11819 WILSHIRE BLVD STE 215
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City | LOS ANGELES
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State | CA
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Zip | 90025-6631
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Country | US
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Telephone | 310-444-8808
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Fax | 310-444-8809
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | ELENA JASSO
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Credential |
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Telephone | 310-444-8808
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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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