Provider Demographics
NPI:1528572559
Name:BEACON SURGICAL CENTER, LLC.
Entity Type:Organization
Organization Name:BEACON SURGICAL CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:NASSIRI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-488-0776
Mailing Address - Street 1:9663 SANTA MONICA BLVD STE 628
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-488-0776
Mailing Address - Fax:
Practice Address - Street 1:414 N CAMDEN DR FL 8
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-488-0776
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-29
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical