Basic Information
| Provider Information | |||||||||
| NPI: | 1811926728 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOTHILL SURGERY CENTER, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FOOTHILL SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 255 E SANTA CLARA ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910067233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262541800 | ||||||||
| FaxNumber: | 6262541808 | ||||||||
| Practice Location | |||||||||
| Address1: | 255 E SANTA CLARA ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | ARCADIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 910067233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262541800 | ||||||||
| FaxNumber: | 6262541808 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2006 | ||||||||
| LastUpdateDate: | 06/10/2011 | ||||||||
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| AuthorizedOfficialLastName: | VARGAS | ||||||||
| AuthorizedOfficialFirstName: | VINA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | BUSINESS OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6262541800 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 930001003 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 3784536 | 05 | CA | MEDICAID |