Provider Demographics
NPI:1922561042
Name:SERRA MEDICAL AMBULATORY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SERRA MEDICAL AMBULATORY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:P
Authorized Official - Last Name:HERSEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-367-7522
Mailing Address - Street 1:2545 W HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91320-2296
Mailing Address - Country:US
Mailing Address - Phone:805-367-7522
Mailing Address - Fax:
Practice Address - Street 1:1120 NEWBURY RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91320-3663
Practice Address - Country:US
Practice Address - Phone:805-367-7522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-08
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical