Provider Demographics
NPI:1841329836
Name:MIRAMAR SURGERY CENTER
Entity type:Organization
Organization Name:MIRAMAR SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:HESTRIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-903-1980
Mailing Address - Street 1:PO BOX 261070
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-1070
Mailing Address - Country:US
Mailing Address - Phone:310-903-1980
Mailing Address - Fax:
Practice Address - Street 1:427 W PUEBLO ST STE C
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-6206
Practice Address - Country:US
Practice Address - Phone:805-682-7222
Practice Address - Fax:805-687-7077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG062996261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical