Provider Demographics
NPI:1407327356
Name:ADVANCED SURGICAL CENTER OF BEVERLY HILLS LLC
Entity Type:Organization
Organization Name:ADVANCED SURGICAL CENTER OF BEVERLY HILLS LLC
Other - Org Name:SURGERY CENTER OF BEVERLY HILLS LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP OF CLINICAL OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:ROTH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:408-761-5847
Mailing Address - Street 1:1871 MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95050-2501
Mailing Address - Country:US
Mailing Address - Phone:408-761-5847
Mailing Address - Fax:408-899-6155
Practice Address - Street 1:8750 WILSHIRE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2725
Practice Address - Country:US
Practice Address - Phone:408-761-5847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-17
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QA0005XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Family Planning Facility