Provider Demographics
NPI:1801384987
Name:EOS WELLNESS SURGERY CENTER LLC
Entity Type:Organization
Organization Name:EOS WELLNESS SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACCREDITATION COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LUANA
Authorized Official - Middle Name:
Authorized Official - Last Name:FARRAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-337-3267
Mailing Address - Street 1:8641 WILSHIRE BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2921
Mailing Address - Country:US
Mailing Address - Phone:310-730-1218
Mailing Address - Fax:310-861-1053
Practice Address - Street 1:8641 WILSHIRE BLVD STE 305
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2921
Practice Address - Country:US
Practice Address - Phone:310-730-1218
Practice Address - Fax:310-861-1053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-25
Last Update Date:2018-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA112498261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical