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NPI Code Detail

MEDICARE: SPECIALTY SURGICAL CENTER OF WESTLAKE VILLAGE, LLC

MEDICARE: SPECIALTY SURGICAL CENTER OF WESTLAKE VILLAGE, 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
1261QA1903XAmbulatory Surgical Clinic/CenterCA
2261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1366643751
Entity Type Code : Organization
Provider Name (Legal Business Name) : SPECIALTY SURGICAL CENTER OF WESTLAKE VILLAGE, LLC
Provider Business Mailing Address
First Line : 696 HAMPSHIRE ROAD
Second Line : SUITE 100
City : WESTLAKE VILLAGE
State : CA
Zip : 91361
Country : US
Telephone Number : 805-413-7920
Fax Number : 805-413-7921
Provider Business Practice Location Address
First Line : 696 HAMPSHIRE ROAD
Second Line : SUITE 100
City : WESTLAKE VILLAGE
State : CA
Zip : 91361-4456
Country : US
Telephone Number : 805-413-7920
Fax Number : 805-413-7921
Authorized Official
Title or Position : OFFICER AND AUTHORIZED OFFICIAL
Name : ERIC BOON
Credential :
Telephone Number : 480-567-0269
Provider Enumeration Date : 05/31/2007
Last Update Date : 07/31/2025

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Directions to “SPECIALTY SURGICAL CENTER OF WESTLAKE VILLAGE, LLC ” Practice Location

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