Provider Demographics
NPI:1316579055
Name:NOVA AMBULATORY SURGERY CENTER LP
Entity type:Organization
Organization Name:NOVA AMBULATORY SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING ACCT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELIDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETTYJOHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-454-5911
Mailing Address - Street 1:PO BOX 3129
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3129
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:855-898-4055
Practice Address - Street 1:4542 LAS POSAS RD STE C
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-2532
Practice Address - Country:US
Practice Address - Phone:805-585-5004
Practice Address - Fax:805-484-3099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-11
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical