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General NPI Number Information
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NPI Number | 1679624233
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Entity Type | Organization
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Legal Business Name | IMAGEBASED SURGICENTER CORPORATION
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2716 OCEAN PARK BLVD SUITE 1007
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City | SANTA MONICA
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State | CA
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Zip | 90405-5207
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Country | US
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Telephone | 310-314-6410
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Fax | 310-314-2414
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Provider Business Mailing Address
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Address Line | 2716 OCEAN PARK BLVD SUITE 1007
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City | SANTA MONICA
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State | CA
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Zip | 90405-5207
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Country | US
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Telephone | 310-314-6410
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Fax | 310-314-2414
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. AARON GERSHON FILLER
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Credential | M.D. PH.D.
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Telephone | 310-314-6410
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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 | 0000694940-AAAHC
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License Number State | CA
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