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General NPI Number Information
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NPI Number | 1902851009
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Entity Type | Organization
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Legal Business Name | 90210 SURGERY MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 01/23/2018
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Provider Practice Location Address
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Address Line | 9735 WILSHIRE BLVD SUITE 100
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-2107
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Country | US
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Telephone | 310-601-3900
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Fax | 310-601-3905
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Provider Business Mailing Address
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Address Line | 3033 N 44TH ST STE 200
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City | PHOENIX
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State | AZ
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Zip | 85018-7244
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Country | US
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Telephone | 480-207-3737
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Fax | 623-266-0053
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Authorized Official
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Title or Position | COO
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Name | MR. BRIAN GIESSLER
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Credential |
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Telephone | 480-207-3716
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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 |
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