Provider Demographics
NPI:1831794049
Name:CALIFORNIA MEDICAL SURGERY CENTER LLC
Entity type:Organization
Organization Name:CALIFORNIA MEDICAL SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:FALK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:805-548-1070
Mailing Address - Street 1:620 CALIFORNIA BLVD STE M
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2526
Mailing Address - Country:US
Mailing Address - Phone:805-548-1070
Mailing Address - Fax:
Practice Address - Street 1:620 CALIFORNIA BLVD STE M
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2526
Practice Address - Country:US
Practice Address - Phone:805-548-1070
Practice Address - Fax:805-548-1071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-03
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty