Provider Demographics
NPI:1194968677
Name:PROFESSIONAL SURGICENTER, INC
Entity type:Organization
Organization Name:PROFESSIONAL SURGICENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RALUAN
Authorized Official - Middle Name:GERARDO
Authorized Official - Last Name:SOLTERO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-450-7694
Mailing Address - Street 1:4510 EXECUTIVE DR STE 105A
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3022
Mailing Address - Country:US
Mailing Address - Phone:858-450-7694
Mailing Address - Fax:858-450-7690
Practice Address - Street 1:4510 EXECUTIVE DR STE 105A
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3022
Practice Address - Country:US
Practice Address - Phone:858-450-7694
Practice Address - Fax:858-450-7690
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-13
Last Update Date:2009-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical