MEDICARE: DIESEL 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	207V00000X	Obstetrics & Gynecology Physician	A86726	CA
2	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1619414018
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIESEL SURGERY CENTER

Provider Business Mailing Address
First Line	:	11645 WILSHIRE BLVD STE 987
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6814
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11645 WILSHIRE BLVD STE 987
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-6814
Country	:	US
Telephone Number	:	310-393-9359
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DAVID GHOZLAND
Credential	:	M.D.
Telephone Number	:	310-393-9359

Provider Enumeration Date	:	01/23/2017
Last Update Date	:	06/16/2018

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Directions to “DIESEL SURGERY CENTER ” Practice Location

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