Provider Demographics
NPI:1477803724
Name:VALENCIA SPECIALTY SURGERY PC
Entity Type:Organization
Organization Name:VALENCIA SPECIALTY SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:P
Authorized Official - Last Name:TAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-388-5240
Mailing Address - Street 1:PO BOX 16297
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90209-2297
Mailing Address - Country:US
Mailing Address - Phone:800-991-6448
Mailing Address - Fax:424-369-9555
Practice Address - Street 1:25802 HEMINGWAY AVE STE 102
Practice Address - Street 2:
Practice Address - City:STEVENSON RANCH
Practice Address - State:CA
Practice Address - Zip Code:91381-2392
Practice Address - Country:US
Practice Address - Phone:800-991-6448
Practice Address - Fax:424-369-9555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-13
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3493924261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3493924OtherCORPORATIONID