Provider Demographics
NPI:1255972642
Name:SANTA MONICA ADVANCED SURGICAL INSTITUTE LLC
Entity type:Organization
Organization Name:SANTA MONICA ADVANCED SURGICAL INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SADIQA
Authorized Official - Middle Name:
Authorized Official - Last Name:STELZNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-829-5475
Mailing Address - Street 1:1908 SANTA MONICA BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-1927
Mailing Address - Country:US
Mailing Address - Phone:310-829-5475
Mailing Address - Fax:
Practice Address - Street 1:1908 SANTA MONICA BLVD STE 5
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-1927
Practice Address - Country:US
Practice Address - Phone:310-829-5475
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical