Provider Demographics
NPI:1801199765
Name:NM GOLDEN STATE SURGICAL SERVIC
Entity Type:Organization
Organization Name:NM GOLDEN STATE SURGICAL SERVIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL BILLER
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-547-4130
Mailing Address - Street 1:2202 S FIGUEROA ST # 600
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-2049
Mailing Address - Country:US
Mailing Address - Phone:520-547-4130
Mailing Address - Fax:520-258-0304
Practice Address - Street 1:2202 S FIGUEROA ST # 600
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-2049
Practice Address - Country:US
Practice Address - Phone:520-547-4130
Practice Address - Fax:520-258-0304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-15
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA261QA1903XOtherTAXONOMY