Provider Demographics
NPI:1023578960
Name:EXCEL SURGICAL CENTER, LLC
Entity Type:Organization
Organization Name:EXCEL SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:ELEANOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MOWBRAY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:310-975-4586
Mailing Address - Street 1:2711 N SEPULVEDA BLVD # 223
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2725
Mailing Address - Country:US
Mailing Address - Phone:310-801-6741
Mailing Address - Fax:
Practice Address - Street 1:120 S SPALDING DR STE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1840
Practice Address - Country:US
Practice Address - Phone:310-857-8528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-25
Last Update Date:2019-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical