Basic Information
| Provider Information | |||||||||
| NPI: | 1780108951 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTELOPE VALLEY SPECIALTY SURGICAL CENTER, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7230 MEDICAL CENTER DR STE 500 | ||||||||
| Address2: | |||||||||
| City: | WEST HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913074024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183487246 | ||||||||
| FaxNumber: | 8183487248 | ||||||||
| Practice Location | |||||||||
| Address1: | 655 W AVENUE Q | ||||||||
| Address2: | |||||||||
| City: | PALMDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 935513894 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8183487246 | ||||||||
| FaxNumber: | 8183487248 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2017 | ||||||||
| LastUpdateDate: | 07/31/2017 | ||||||||
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| AuthorizedOfficialLastName: | RIEDEL | ||||||||
| AuthorizedOfficialFirstName: | REBECCA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR OF NURSING | ||||||||
| AuthorizedOfficialTelephone: | 8183487251 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
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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.