Basic Information
| Provider Information | |||||||||
| NPI: | 1700910262 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SOUTHERN CALIFORNIA SURGICAL SPECIALISTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1044 SOUTH FAIR OAKS AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267959023 | ||||||||
| FaxNumber: | 6267971731 | ||||||||
| Practice Location | |||||||||
| Address1: | 1044 S FAIR OAKS AVE | ||||||||
| Address2: | SUITE 301 | ||||||||
| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911052622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6267959023 | ||||||||
| FaxNumber: | 6267971731 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/15/2007 | ||||||||
| LastUpdateDate: | 09/03/2009 | ||||||||
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| AuthorizedOfficialLastName: | KWAN | ||||||||
| AuthorizedOfficialFirstName: | VALERIE | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3103603922 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | A62828 | CA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.