Basic Information
| Provider Information | |||||||||
| NPI: | 1689831760 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | REXFORD SURGICAL INSTITUTE, INC. | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | AVOSANT SURGICAL ASSOCIATES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9301 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902105424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102743484 | ||||||||
| FaxNumber: | 3102743482 | ||||||||
| Practice Location | |||||||||
| Address1: | 9301 WILSHIRE BLVD | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902105424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102743484 | ||||||||
| FaxNumber: | 3102743482 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/17/2008 | ||||||||
| LastUpdateDate: | 01/30/2014 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | RAMIREZ | ||||||||
| AuthorizedOfficialFirstName: | GRISELDA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 3102743484 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | G076581 | 01 | CA | PROVIDER MEDICAL LICENCE | OTHER | FG0546450 | 01 | CA | DEA | OTHER |