Provider Demographics
NPI:1932641420
Name:AST SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:AST SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GHODADRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-801-6741
Mailing Address - Street 1:9675 BRIGHTON WAY STE B1
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5144
Mailing Address - Country:US
Mailing Address - Phone:310-801-6741
Mailing Address - Fax:310-227-8221
Practice Address - Street 1:120 S SPALDING DR STE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-1840
Practice Address - Country:US
Practice Address - Phone:310-857-8528
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-15
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA116163261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical