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General NPI Number Information
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NPI Number | 1760987374
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Entity Type | Organization
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Legal Business Name | IVY SURGICAL CENTER, LLC
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 03/26/2018
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Provider Practice Location Address
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Address Line | 9701 WILSHIRE BLVD
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-2020
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Country | US
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Telephone | 310-598-2648
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Fax |
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Provider Business Mailing Address
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Address Line | 9701 WILSHIRE BLVD ML1
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-2020
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Country | US
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Telephone | 310-598-2648
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Fax |
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Authorized Official
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Title or Position | MD/CEO
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Name | DANIEL BARRETT
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Credential |
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Telephone | 310-598-2648
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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 | A110166
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License Number State | CA
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