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General NPI Number Information
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NPI Number | 1922138817
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Entity Type | Organization
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Legal Business Name | CULVER CITY SURGICAL SPECIALISTS, INC
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Dates
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Enumeration Date | 03/07/2007
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 3831 HUGHES AVE. SUITE 702
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City | CULVER CITY
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State | CA
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Zip | 90232-6843
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Country | US
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Telephone | 310-837-3668
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Fax | 310-837-3015
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Provider Business Mailing Address
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Address Line | 3831 HUGHES AVE. SUITE 702
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City | CULVER CITY
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State | CA
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Zip | 90232-6843
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Country | US
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Telephone | 310-837-3668
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Fax | 310-837-3015
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Authorized Official
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Title or Position | OWNER
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Name | PAUL JAMES BRODY
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Credential | DPM
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Telephone | 310-837-3668
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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 | 418171
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License Number State | CA
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