Provider Demographics
NPI:1063422962
Name:SAN ANTONIO AMBULATORY SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:SAN ANTONIO AMBULATORY SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CALEB
Authorized Official - Middle Name:PERRY
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-579-1500
Mailing Address - Street 1:901 SAN BERNARDINO RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4912
Mailing Address - Country:US
Mailing Address - Phone:909-579-1500
Mailing Address - Fax:909-579-1510
Practice Address - Street 1:901 SAN BERNARDINO RD
Practice Address - Street 2:SUITE 201
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4912
Practice Address - Country:US
Practice Address - Phone:909-579-1500
Practice Address - Fax:909-579-1510
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2024-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA240000773261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ19753ZMedicare ID - Type Unspecified