Provider Demographics
NPI:1982043428
Name:THE ADVANCED SURGICAL INSTITUTE OF RANCHO CUCAMONGA, LLC
Entity Type:Organization
Organization Name:THE ADVANCED SURGICAL INSTITUTE OF RANCHO CUCAMONGA, LLC
Other - Org Name:THE ADVANCED SURGICAL INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MAZIN
Authorized Official - Middle Name:S
Authorized Official - Last Name:AL-HAKEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-373-4380
Mailing Address - Street 1:8112 MILLIKEN AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7471
Mailing Address - Country:US
Mailing Address - Phone:909-373-4380
Mailing Address - Fax:909-373-4388
Practice Address - Street 1:19671 BEACH BLVD
Practice Address - Street 2:SUITE 321
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-5901
Practice Address - Country:US
Practice Address - Phone:714-969-2520
Practice Address - Fax:714-969-7480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical