MEDICARE: MURRIETA SPECIALTY SURGERY CENTER PC A PROFESSIONAL CORPORATION

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		CA

General Provider Information

NPI Number	:	1902284045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MURRIETA SPECIALTY SURGERY CENTER PC A PROFESSIONAL CORPORATION

Provider Business Mailing Address
First Line	:	PO BOX 16297
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90209-2297
Country	:	US
Telephone Number	:	800-991-6448
Fax Number	:	424-369-9555

Provider Business Practice Location Address
First Line	:	40663 MURRIETA HOT SPRINGS RD
Second Line	:	SUITE C4
City	:	MURRIETA
State	:	CA
Zip	:	92562-9022
Country	:	US
Telephone Number	:	800-991-6448
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DANIEL TAHERI
Credential	:	M.D
Telephone Number	:	310-446-9007

Provider Enumeration Date	:	05/08/2015
Last Update Date	:	12/06/2021

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