Provider Demographics
NPI:1154593481
Name:RANCHO MIRAGE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:RANCHO MIRAGE SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LILLI
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANDELIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-699-6500
Mailing Address - Street 1:35-800 BOB HOPE DRIVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-1722
Mailing Address - Country:US
Mailing Address - Phone:760-699-6500
Mailing Address - Fax:760-699-6555
Practice Address - Street 1:35-800 BOB HOPE DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-1722
Practice Address - Country:US
Practice Address - Phone:760-699-6500
Practice Address - Fax:760-699-6555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical