Provider Demographics
NPI:1811921752
Name:GLENDORA SURGERY CENTER
Entity type:Organization
Organization Name:GLENDORA SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAJIB
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-963-4124
Mailing Address - Street 1:541 S PASADENA AVE
Mailing Address - Street 2:#101
Mailing Address - City:GLENDORA
Mailing Address - State:CA
Mailing Address - Zip Code:91741
Mailing Address - Country:US
Mailing Address - Phone:626-610-1850
Mailing Address - Fax:626-963-8691
Practice Address - Street 1:541 S PASADENA AVE
Practice Address - Street 2:#101
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91741
Practice Address - Country:US
Practice Address - Phone:626-610-1850
Practice Address - Fax:626-963-8691
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
005270Medicare ID - Type Unspecified