Basic Information
| Provider Information | |||||||||
| NPI: | 1922293976 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PALM SURGICAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 250 S LA CIENEGA BLVD | ||||||||
| Address2: | # 204 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902113302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103589300 | ||||||||
| FaxNumber: | 3103589156 | ||||||||
| Practice Location | |||||||||
| Address1: | 250 S LA CIENEGA BLVD | ||||||||
| Address2: | # 204 | ||||||||
| City: | BEVERLY HILLS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902113302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103589300 | ||||||||
| FaxNumber: | 3103589156 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2007 | ||||||||
| LastUpdateDate: | 09/12/2007 | ||||||||
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| AuthorizedOfficialLastName: | MALEK | ||||||||
| AuthorizedOfficialFirstName: | MASOUD | ||||||||
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| AuthorizedOfficialTitleorPosition: | DR. MASOUD MALEK | ||||||||
| AuthorizedOfficialTelephone: | 3103589300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | A038198 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.