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General NPI Number Information
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NPI Number | 1992573513
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Entity Type | Organization
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Legal Business Name | CULL CANYON SURGERY CENTER LLC
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Dates
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Enumeration Date | 12/13/2023
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Last Update Date | 12/13/2023
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Provider Practice Location Address
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Address Line | 20998 REDWOOD RD
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5918
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Country | US
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Telephone | 818-855-1507
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Fax |
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Provider Business Mailing Address
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Address Line | 425 15TH ST UNIT 3195
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-7316
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Country | US
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Telephone | 818-855-1507
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Fax |
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Authorized Official
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Title or Position | COO
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Name | MISS PELIN SEN
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Credential | MBA
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Telephone | 310-382-7539
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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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