PREMIER SURGICAL PAVILION OF LA (NPI# 1114589793) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1114589793 |
| Entity Type | Organization |
| Organization Name | PREMIER SURGICAL PAVILION OF LA |
| Practice Address |
11661 San Vicente Blvd Los Angeles CA 90049-5103 |
| Mailing Address |
115 E 39th St New York NY 10016-0943 |
| Practice Telephone | 2122230716 |
| Mailing Telephone | 2122230716 |
| Enumeration Date | 2019-07-03 |
| Last Update Date | 2019-07-03 |
| Authorized Official Name | DR. MICHAEL EUGENE JONES (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 2122230716 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| CA | MEDICAL LICENSE | C53266 | 01 |
| Street Address |
11661 SAN VICENTE BLVD |
| City | LOS ANGELES |
| State | CA |
| Zip Code | 90049-5103 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194927822 | Jocelyn Carol Stamat | Otolaryngology | 11661 San Vicente Blvd, Suite 101, Los Angeles, CA 90049-5103 | 2007-06-04 |
| 1033561022 | Mary Rownaghi | Nurse Practitioner | 11661 San Vicente Blvd, #101, Los Angeles, CA 90049-5103 | 2016-07-01 |
| 1891156980 | Jeannine Nahabedian | Physician Assistant | 11661 San Vicente Blvd, 101, Los Angeles, CA 90049-5103 | 2016-03-16 |
| 1275849325 | Aaron Hunter Sones | Independent Medical Examiner | 11661 San Vicente Blvd, 1035, Los Angeles, CA 90049-5103 | 2010-08-27 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1316564339 | Kepp Family & Group Practice | Marriage & Family Therapist | 12011 San Vincente Blvd, 408, Los Angeles, CA 90049 | 2020-06-26 |
| 1386204493 | Steven J Lehrman | Marriage & Family Therapist | 179 S. Barrington Place, Office A, Los Angeles, CA 90049 | 2019-06-20 |
| 1922562990 | Jand. Inc. | Eyewear Supplier (Equipment, not the service) | 860 S. Sepulveda Blvd., Los Angeles, CA 90049 | 2019-01-24 |
| 1851864946 | Christie Schnur | Marriage & Family Therapist | 11911 San Vicente Blvd., Los Angeles, CA 90049 | 2019-01-10 |
| 1669954012 | Barbara Jiji Schenk | Marriage & Family Therapist | 520 S. Sepulveda Blvd #402, Los Angeles, CA 90049 | 2018-09-02 |
| 1972090710 | Community Reflections Inc | Counselor | 10020 So. Western Ave, 10020 So. Western Ave, Los Angeles, CA 90049 | 2018-04-17 |
| 1245738830 | Dr. Shirin Tabib LLC | Marriage & Family Therapist | 61133 San Vincent Blvd, Suite 318 A, Los Angeles, CA 90049 | 2018-01-29 |
| 1295240679 | Robert A Brooks | Preventive Medicine | 149 South Barrington Ave, #346, Los Angeles, CA 90049 | 2017-12-07 |
| 1598286478 | Marvin S Serrano | Physical Therapy Assistant | 11740 San Vicente Boulevard Suite 205, Los Angeles, CA 90049 | 2017-06-30 |
| 1972055812 | Evolve Growth Initiatives, LLC | Psychiatric Residential Treatment Facility | 820 Moraga Drive, Los Angeles, CA 90049 | 2016-10-26 |
| Find all providers in zip 90049 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1609473420 | Alden Advanced Surgicenter LLC | Clinic/Center | 8741 Alden Drive, Suite B, Los Angeles, CA 90048 | 2020-10-05 |
| 1912542994 | Reproductive Medicine Associates of Socal Ambulatory Surgery Center | Clinic/Center | 11500 W Olympic Blvd, Ste# 150, Los Angeles, CA 90064 | 2019-11-13 |
| 1659926327 | Westside Anesthesia Group A Medical Corporation | Clinic/Center | 1964 Westwood Blvd Ste 436, Los Angeles, CA 90025-4695 | 2019-08-08 |
| 1558832741 | Grand Avenue Surgery Center, LLC | Clinic/Center | 1513 S Grand Ave Ste 350, Los Angeles, CA 90015-3075 | 2018-12-16 |
| 1700351194 | Integrative Surgical Associates Group, LLC. | Clinic/Center | 5757 Wilshire Blvd # P2, Los Angeles, CA 90036-5810 | 2018-10-11 |
| 1982180782 | Robertson Surgery Center Inc. | Clinic/Center | 822 S Robertson Blvd Ste 100b, Los Angeles, CA 90035-1613 | 2018-07-14 |
| 1972055382 | Alliance Surgery Partners, LLC | Clinic/Center | 1828 E Cesar Chavez Ave, Los Angeles, CA 90033-2424 | 2016-11-02 |
| 1164895744 | Los Angeles Ambulatory Surgery Center LLC | Clinic/Center | 266 S Harvard Blvd Ste 200, Los Angeles, CA 90004-4339 | 2015-11-04 |
| 1255752747 | Elite Surgery Center of Beverly Hills | Clinic/Center | 6310 San Vicente Blvd Ste 101b, Los Angeles, CA 90048-5498 | 2013-12-30 |
| 1942548003 | Sierra Surgical Services, LLC | Clinic/Center | 2202 S Figueroa St # 6601, Los Angeles, CA 90007-2049 | 2013-01-24 |
| Find all providers in LOS ANGELES | ||||
| City | LOS ANGELES |
| Zip Code | 90049 |
Please comment or provide details below to improve the information on PREMIER SURGICAL PAVILION OF LA.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.