Provider Demographics
NPI:1306399514
Name:RADIANT SURGICAL CENTER INC
Entity Type:Organization
Organization Name:RADIANT SURGICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAMOD
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:SRIVASTAVA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-496-0887
Mailing Address - Street 1:9610 STOCKDALE HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3625
Mailing Address - Country:US
Mailing Address - Phone:661-496-0887
Mailing Address - Fax:
Practice Address - Street 1:9610 STOCKDALE HWY
Practice Address - Street 2:SUITE A
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3625
Practice Address - Country:US
Practice Address - Phone:661-496-0887
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-25
Last Update Date:2016-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51256261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical