Provider Demographics
NPI:1417410242
Name:SERRA SURGERY CENTER LLC
Entity Type:Organization
Organization Name:SERRA SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-367-7522
Mailing Address - Street 1:1120 NEWBURY RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-3663
Mailing Address - Country:US
Mailing Address - Phone:310-901-2383
Mailing Address - Fax:805-379-9134
Practice Address - Street 1:1120 NEWBURY RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-3663
Practice Address - Country:US
Practice Address - Phone:310-901-2383
Practice Address - Fax:805-379-9134
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-09
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical