Basic Information
| Provider Information | |||||||||
| NPI: | 1699703991 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLAZA SURGICAL MEDICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 850 S ATLANTIC BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917544730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262892894 | ||||||||
| FaxNumber: | 6263082083 | ||||||||
| Practice Location | |||||||||
| Address1: | 850 S ATLANTIC BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | MONTEREY PARK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917544730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262892894 | ||||||||
| FaxNumber: | 6263082083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 03/28/2008 | ||||||||
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| AuthorizedOfficialLastName: | ONTIVEROS | ||||||||
| AuthorizedOfficialFirstName: | ALICIA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 6262890178 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 31325 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.