Provider Demographics
NPI: | 1952428989 |
---|---|
Name: | THE ADVANCED SURGICAL INSTITUTE,INC. |
Entity Type: | Organization |
Organization Name: | THE ADVANCED SURGICAL INSTITUTE,INC. |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | MEDICAL DIRECTOR |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | MAZIN |
Authorized Official - Middle Name: | SULTAN |
Authorized Official - Last Name: | AL-HAKEEM |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 714-969-2520 |
Mailing Address - Street 1: | 19671 BEACH BLVD |
Mailing Address - Street 2: | SUITE 321 |
Mailing Address - City: | HUNTINGTON BEACH |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 92648-5901 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 714-969-2520 |
Mailing Address - Fax: | 714-969-7480 |
Practice Address - Street 1: | 19671 BEACH BLVD |
Practice Address - Street 2: | SUITE 321 |
Practice Address - City: | HUNTINGTON BEACH |
Practice Address - State: | CA |
Practice Address - Zip Code: | 92648-5901 |
Practice Address - Country: | US |
Practice Address - Phone: | 714-969-2520 |
Practice Address - Fax: | 714-969-7480 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2007-03-23 |
Last Update Date: | 2010-12-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QA1903X | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |