Provider Demographics
NPI:1588191167
Name:HIGH DESERT AMBULATORY SURGICAL CENTER INC
Entity Type:Organization
Organization Name:HIGH DESERT AMBULATORY SURGICAL CENTER INC
Other - Org Name:A & A SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PARASTOU
Authorized Official - Middle Name:
Authorized Official - Last Name:ILBEIGI
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:760-515-6260
Mailing Address - Street 1:18400 US HIGHWAY 18 STE A
Mailing Address - Street 2:
Mailing Address - City:APPLE VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92307-2306
Mailing Address - Country:US
Mailing Address - Phone:760-242-3939
Mailing Address - Fax:949-863-8505
Practice Address - Street 1:12241 INDUSTRIAL BLVD STE 101
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-7795
Practice Address - Country:US
Practice Address - Phone:760-881-3933
Practice Address - Fax:949-863-8505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical