Provider Demographics
NPI:1073999033
Name:CANON SURGERY CENTER
Entity Type:Organization
Organization Name:CANON SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDRE
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-276-4494
Mailing Address - Street 1:9400 BRIGHTON WAY
Mailing Address - Street 2:SUITE 405
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4714
Mailing Address - Country:US
Mailing Address - Phone:310-276-4494
Mailing Address - Fax:310-276-8988
Practice Address - Street 1:9400 BRIGHTON WAY
Practice Address - Street 2:SUITE 405
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4714
Practice Address - Country:US
Practice Address - Phone:310-276-4494
Practice Address - Fax:310-276-8988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical