Provider Demographics
NPI:1225648470
Name:UCSD AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:UCSD AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:
Authorized Official - Last Name:PEOPLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-657-0055
Mailing Address - Street 1:4120 LA JOLLA VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1406
Mailing Address - Country:US
Mailing Address - Phone:858-657-0055
Mailing Address - Fax:858-657-0066
Practice Address - Street 1:4120 LA JOLLA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1406
Practice Address - Country:US
Practice Address - Phone:858-657-0055
Practice Address - Fax:858-657-0066
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UCSD AMBULATORY SURGERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical