Provider Demographics
NPI:1275715922
Name:VENICE BEACH SURGICAL CENTER
Entity Type:Organization
Organization Name:VENICE BEACH SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AUGUSTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROJAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-391-7143
Mailing Address - Street 1:11961 VENICE BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-3900
Mailing Address - Country:US
Mailing Address - Phone:310-391-7143
Mailing Address - Fax:310-397-9688
Practice Address - Street 1:11961 VENICE BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-3900
Practice Address - Country:US
Practice Address - Phone:310-391-7143
Practice Address - Fax:310-397-9688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41262261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical