Provider Demographics
NPI:1093891004
Name:SUNSET SURGICAL CENTER A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:SUNSET SURGICAL CENTER A MEDICAL CORPORATION
Other - Org Name:SUNSET SURGICAL CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLER/OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-338-4545
Mailing Address - Street 1:222 N SUNSET AVE STE A
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-2278
Mailing Address - Country:US
Mailing Address - Phone:626-338-4545
Mailing Address - Fax:626-869-0387
Practice Address - Street 1:222 N SUNSET AVE STE A
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-2278
Practice Address - Country:US
Practice Address - Phone:626-338-4545
Practice Address - Fax:626-869-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-31
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABUSINESS LICENS08034261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051494Medicare UPIN