Provider Demographics
NPI:1235132481
Name:CYPRESS AMBULATORY SURGERY CENTER
Entity Type:Organization
Organization Name:CYPRESS AMBULATORY SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:INNA
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIBANOVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:805-782-8132
Mailing Address - Street 1:PO BOX 5435
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93403-5435
Mailing Address - Country:US
Mailing Address - Phone:805-782-8132
Mailing Address - Fax:805-597-8350
Practice Address - Street 1:1300 E CYPRESS ST
Practice Address - Street 2:STE E1
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4736
Practice Address - Country:US
Practice Address - Phone:805-782-8132
Practice Address - Fax:805-597-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-23
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051521Medicare PIN