Provider Demographics
NPI:1558515015
Name:GENESIS SURGICAL CENTER
Entity Type:Organization
Organization Name:GENESIS SURGICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASUSHI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAMURA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-237-4523
Mailing Address - Street 1:18351 COLIMA RD STE 408
Mailing Address - Street 2:
Mailing Address - City:ROWLAND HEIGHTS
Mailing Address - State:CA
Mailing Address - Zip Code:91748-2791
Mailing Address - Country:US
Mailing Address - Phone:909-902-5588
Mailing Address - Fax:909-902-1013
Practice Address - Street 1:11760 CENTRAL AVE STE 204
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-1909
Practice Address - Country:US
Practice Address - Phone:909-902-5588
Practice Address - Fax:909-902-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-11
Last Update Date:2011-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical