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General NPI Number Information
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NPI Number | 1922561042
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Entity Type | Organization
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Legal Business Name | SERRA MEDICAL AMBULATORY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 10/01/2019
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Provider Practice Location Address
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Address Line | 1120 NEWBURY RD
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-3663
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Country | US
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Telephone | 805-367-7522
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Fax |
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Provider Business Mailing Address
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Address Line | 2545 W HILLCREST DR
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City | THOUSAND OAKS
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State | CA
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Zip | 91320-2296
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Country | US
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Telephone | 805-367-7522
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. ALEXANDER P HERSEL
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Credential | MD
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Telephone | 805-367-7522
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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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