Provider Demographics
NPI:1760581342
Name:OUTPATIENT SURGERY OF POINT LOMA
Entity Type:Organization
Organization Name:OUTPATIENT SURGERY OF POINT LOMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:KUPFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-223-2271
Mailing Address - Street 1:12021 WILSHIRE BLVD
Mailing Address - Street 2:#864
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1206
Mailing Address - Country:US
Mailing Address - Phone:310-471-5852
Mailing Address - Fax:310-472-9582
Practice Address - Street 1:3434 MIDWAY DR
Practice Address - Street 2:#1006
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-4923
Practice Address - Country:US
Practice Address - Phone:619-223-2271
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01268FMedicaid
CASUR01268FMedicaid