Basic Information
| Provider Information | |||||||||
| NPI: | 1316190077 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CERRITOS SURGERY CENTER, LLC | ||||||||
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| OtherOrganizationName: | CERRITOS SURGERY CENTER, LLC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16543 CARMENITA AVENUE | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622197251 | ||||||||
| FaxNumber: | 5622197290 | ||||||||
| Practice Location | |||||||||
| Address1: | 16543 CARMENITA AVENUE | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907032218 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5622197251 | ||||||||
| FaxNumber: | 5622197252 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2008 | ||||||||
| LastUpdateDate: | 11/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | JAIME | ||||||||
| AuthorizedOfficialFirstName: | JAQUI | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMIN | ||||||||
| AuthorizedOfficialTelephone: | 5622197251 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.