Provider Demographics
NPI:1720386519
Name:SAN DIEGO SURGERY LLC
Entity Type:Organization
Organization Name:SAN DIEGO SURGERY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR, B&C
Authorized Official - Prefix:MS
Authorized Official - First Name:ARA
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-273-8885
Mailing Address - Street 1:9903 SANTA MONICA BLVD
Mailing Address - Street 2:#811
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-1671
Mailing Address - Country:US
Mailing Address - Phone:310-273-8885
Mailing Address - Fax:
Practice Address - Street 1:3434 MIDWAY DR
Practice Address - Street 2:1008
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4923
Practice Address - Country:US
Practice Address - Phone:310-273-8885
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84519174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty