MEDICARE: MONTEBELLO SURGERY CENTER

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	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1265562045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTEBELLO SURGERY CENTER

Provider Business Mailing Address
First Line	:	229 EAST BEVERLY BLVD.
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640
Country	:	US
Telephone Number	:	323-728-5814
Fax Number	:

Provider Business Practice Location Address
First Line	:	229 E BEVERLY BLVD
Second Line	:
City	:	MONTEBELLO
State	:	CA
Zip	:	90640-3776
Country	:	US
Telephone Number	:	323-728-5814
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. REGINALD SAMPSON
Credential	:	M.D.
Telephone Number	:	323-728-5814

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	08/22/2020

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Directions to “MONTEBELLO SURGERY CENTER ” Practice Location

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