PREMIER SURGICAL PAVILION OF LA NPI 1114589793

NPI Information

NPI: 1114589793
Provider Name: PREMIER SURGICAL PAVILION OF LA
Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

CLIA Number: 05D2194751

Address:
11661 SAN VICENTE BLVD
LOS ANGELES, CA
ZIP 90049
Phone: (212) 223-0716
Get Directions

PREMIER SURGICAL PAVILION OF LA is an ambulatory surgical clinic center in Los Angeles, CA. PREMIER SURGICAL PAVILION OF LA NPI is 1114589793. The provider is registered as an organization entity type.

The provider's business location address is:

11661 SAN VICENTE BLVD
LOS ANGELES, CA
ZIP 90049-103
Phone: (212) 223-0716

The provider's authorized official is Michael Eugene Jones .
The authorized official title is Medical Director and has the following contact phone number (212) 223-0716.

The CLIA number assigned to this NPI record is 05D2194751 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/3/2019 and was last updated on 7/3/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	C53266	OTHER	CALIFORNIA	MEDICAL LICENSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.

« Previous NPI

Next NPI »