Provider Demographics
NPI:1275015414
Name:INTEGRITY SSURGICAL CENTER INC.
Entity Type:Organization
Organization Name:INTEGRITY SSURGICAL CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:SOROKURS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-622-5369
Mailing Address - Street 1:221 N SAN DIMAS AVE # 201
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-2664
Mailing Address - Country:US
Mailing Address - Phone:909-592-0142
Mailing Address - Fax:909-592-0339
Practice Address - Street 1:221 N SAN DIMAS AVE # 201
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2664
Practice Address - Country:US
Practice Address - Phone:909-592-0142
Practice Address - Fax:909-592-0339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208600000X
261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty