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General NPI Number Information
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NPI Number | 1831177567
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Entity Type | Organization
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Legal Business Name | DE ANZA SURGERY CENTER
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 10/09/2008
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Provider Practice Location Address
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Address Line | 4444 MAGNOLIA AVE SUITE C
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City | RIVERSIDE
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State | CA
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Zip | 92501-4136
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Country | US
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Telephone | 951-320-7799
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Fax | 951-274-3550
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Provider Business Mailing Address
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Address Line | 4444 MAGNOLIA AVE SUITE C
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City | RIVERSIDE
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State | CA
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Zip | 92501-4136
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Country | US
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Telephone | 951-320-7799
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Fax | 951-274-3550
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Authorized Official
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Title or Position | CEO/ADMINISTRATOR
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Name | MR. EDWARD J TENNANT
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Credential | CASC
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Telephone | 951-320-7799
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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 | 250000795
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License Number State | CA
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