Basic Information
| Provider Information | |||||||||
| NPI: | 1114043858 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AZUSA SURGERY CENTER LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 515801 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900515801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9094933800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 830 S. CITRUS AVE | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | AZUSA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6265431560 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 04/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | VARGA | ||||||||
| AuthorizedOfficialFirstName: | CLAYTON | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 6266961400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D | ||||||||
| NPICertificationDate: | 04/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.