Provider Demographics
NPI:1447420054
Name:MISSION VALLEY OUTPATIENT SURGERY CENTER
Entity Type:Organization
Organization Name:MISSION VALLEY OUTPATIENT SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:WHITE
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:619-298-2200
Mailing Address - Street 1:2878 CAMINO DEL RIO SOUTH
Mailing Address - Street 2:210
Mailing Address - City:SD
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-298-2200
Mailing Address - Fax:619-298-2250
Practice Address - Street 1:2878 CAMINO DEL RIO SOUTH
Practice Address - Street 2:215
Practice Address - City:SD
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-298-2200
Practice Address - Fax:619-298-2250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-11
Last Update Date:2011-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31922261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical