MEDICARE: KERLAN-JOBE SURGERY CENTER LLC

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	:	1366408270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KERLAN-JOBE SURGERY CENTER LLC

Provider Business Mailing Address
First Line	:	6801 PARK TER
Second Line	:	SUITE 300
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1543
Country	:	US
Telephone Number	:	310-665-7150
Fax Number	:

Provider Business Practice Location Address
First Line	:	6801 PARK TER STE 300
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-9212
Country	:	US
Telephone Number	:	310-665-7200
Fax Number	:

Authorized Official
Title or Position	:	PARTNER
Name	:	RALPH ANTHONY GAMBARDELLA
Credential	:	MD
Telephone Number	:	310-792-3914

Provider Enumeration Date	:	04/21/2006
Last Update Date	:	11/09/2018

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