Provider Demographics
NPI:1770861346
Name:ORANGE GROVE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ORANGE GROVE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ATTORNEY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SILVERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-230-5741
Mailing Address - Street 1:1980 N ORANGE GROVE AVE
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-3008
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8581 SANTA MONICA BLVD # 968
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4120
Practice Address - Country:US
Practice Address - Phone:310-230-5741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOCAL SURGERY CENTERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-29
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical