Provider Demographics
NPI:1558625731
Name:STELLAR SURGICAL SPECIALTIES, INC.
Entity Type:Organization
Organization Name:STELLAR SURGICAL SPECIALTIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:A
Authorized Official - Last Name:VARGA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-696-1400
Mailing Address - Street 1:PO BOX 515825
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90051-3125
Mailing Address - Country:US
Mailing Address - Phone:909-493-3800
Mailing Address - Fax:909-204-7868
Practice Address - Street 1:69780 STELLAR DRIVE
Practice Address - Street 2:SUITE B
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2954
Practice Address - Country:US
Practice Address - Phone:760-424-3399
Practice Address - Fax:760-424-3379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-02
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical