Provider Demographics
NPI:1811133663
Name:COVINA SURGERY CENTER, LLC
Entity type:Organization
Organization Name:COVINA SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:KHALAF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-966-2222
Mailing Address - Street 1:246 W COLLEGE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-1910
Mailing Address - Country:US
Mailing Address - Phone:626-966-2222
Mailing Address - Fax:866-398-7641
Practice Address - Street 1:246 W COLLEGE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-1910
Practice Address - Country:US
Practice Address - Phone:626-966-2222
Practice Address - Fax:866-398-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical