MEDICARE: PACIFIC SURGICAL CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0102X	Surgical Critical Care Physician

General Provider Information

NPI Number	:	1104461300
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PACIFIC SURGICAL CARE

Provider Business Mailing Address
First Line	:	1215 BROCKTON AVE APT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1390
Country	:	US
Telephone Number	:	631-294-1942
Fax Number	:

Provider Business Practice Location Address
First Line	:	1215 BROCKTON AVE APT 205
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1390
Country	:	US
Telephone Number	:	631-294-1942
Fax Number	:

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	HELEN JARAMILLO
Credential	:
Telephone Number	:	631-294-1942

Provider Enumeration Date	:	11/12/2019
Last Update Date	:	11/12/2019

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Directions to “PACIFIC SURGICAL CARE ” Practice Location

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