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General NPI Number Information
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NPI Number | 1922828284
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Entity Type | Organization
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Legal Business Name | KECK MEDICINE OF USC SURGERY CENTER, PASADENA - LLC
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Dates
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Enumeration Date | 10/11/2024
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 590 S FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91105-2614
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Country | US
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Telephone | 323-442-8747
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Fax |
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Provider Business Mailing Address
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Address Line | 590 S FAIR OAKS AVE
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City | PASADENA
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State | CA
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Zip | 91105-2614
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Country | US
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Telephone | 323-442-8747
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Fax |
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Authorized Official
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Title or Position | CFO/USC CARE MEDICAL GROUP, INC.
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Name | JEREMY CHURCH
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Credential |
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Telephone | 323-442-8747
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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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