Provider Demographics
NPI:1881690949
Name:ADVANCED AMBULATORY SURGERY CENTER LP
Entity Type:Organization
Organization Name:ADVANCED AMBULATORY SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUZI
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-560-5125
Mailing Address - Street 1:PO BOX 30538
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90030-0538
Mailing Address - Country:US
Mailing Address - Phone:909-557-1704
Mailing Address - Fax:909-557-1730
Practice Address - Street 1:1901 W LUGONIA AVE
Practice Address - Street 2:STE 100
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-9704
Practice Address - Country:US
Practice Address - Phone:909-557-1700
Practice Address - Fax:909-557-1730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-23
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000011261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical