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General NPI Number Information
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NPI Number | 1912393737
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Entity Type | Organization
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Legal Business Name | MILLS SURGERY CENTER
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Dates
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Enumeration Date | 04/08/2015
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Last Update Date | 04/08/2015
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Provider Practice Location Address
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Address Line | 4480 E. MILLS CIRCLE
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City | ONTARIO
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State | CA
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Zip | 91764-5206
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Country | US
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Telephone | 909-294-2033
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Fax | 909-933-6585
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Provider Business Mailing Address
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Address Line | 4480 E. MILLS CIRCLE
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City | ONTARIO
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State | CA
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Zip | 91764-5206
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Country | US
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Telephone |
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Fax | 909-933-6585
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | GREGORY RAYMOND LERCEL
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Credential | M.D.
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Telephone | 626-298-3123
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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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