Provider Demographics
NPI:1316190077
Name:CERRITOS SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:CERRITOS SURGERY CENTER, LLC
Other - Org Name:CERRITOS SURGERY CENTER, LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:JAQUI
Authorized Official - Middle Name:V
Authorized Official - Last Name:JAIME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-219-7251
Mailing Address - Street 1:16543 CARMENITA AVENUE
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-2218
Mailing Address - Country:US
Mailing Address - Phone:562-219-7251
Mailing Address - Fax:562-219-7290
Practice Address - Street 1:16543 CARMENITA AVENUE
Practice Address - Street 2:
Practice Address - City:CERRITOS
Practice Address - State:CA
Practice Address - Zip Code:90703-2218
Practice Address - Country:US
Practice Address - Phone:562-219-7251
Practice Address - Fax:562-219-7252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical