Provider Demographics
NPI:1881015584
Name:ACE ENDOSCOPY AND SURGERY CENTER
Entity Type:Organization
Organization Name:ACE ENDOSCOPY AND SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:KUMARAVELU
Authorized Official - Middle Name:
Authorized Official - Last Name:BALASUBRAMANIAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-881-3032
Mailing Address - Street 1:2006 N. RIVERSIDE AVENUE
Mailing Address - Street 2:SUITE A
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376
Mailing Address - Country:US
Mailing Address - Phone:909-881-3032
Mailing Address - Fax:909-881-0668
Practice Address - Street 1:2006 N. RIVERSIDE AVENUE
Practice Address - Street 2:SUITE A
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376
Practice Address - Country:US
Practice Address - Phone:909-881-3032
Practice Address - Fax:909-881-0668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-23
Last Update Date:2013-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical