Basic Information
| Provider Information | |||||||||
| NPI: | 1194299586 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CONCIERGE SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 860 OAK PARK BLVD STE 202 | ||||||||
| Address2: | |||||||||
| City: | ARROYO GRANDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934201800 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054746383 | ||||||||
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| Practice Location | |||||||||
| Address1: | 23365 HAWTHORNE BLVD STE 103 | ||||||||
| Address2: | |||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905053736 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054746383 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2019 | ||||||||
| LastUpdateDate: | 08/09/2019 | ||||||||
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| AuthorizedOfficialLastName: | FARRAR | ||||||||
| AuthorizedOfficialFirstName: | LUANA | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING | ||||||||
| AuthorizedOfficialTelephone: | 9493373267 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.