Provider Demographics
NPI:1457624231
Name:DR MONA MISRA ADVANCED SURGICAL SPECIALISTS PC
Entity type:Organization
Organization Name:DR MONA MISRA ADVANCED SURGICAL SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONALI
Authorized Official - Middle Name:
Authorized Official - Last Name:MISRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-280-1135
Mailing Address - Street 1:8631 W 3RD ST
Mailing Address - Street 2:SUITE 540 E
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5901
Mailing Address - Country:US
Mailing Address - Phone:424-999-5677
Mailing Address - Fax:213-260-9356
Practice Address - Street 1:8631 W 3RD ST
Practice Address - Street 2:SUITE 540 E
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5901
Practice Address - Country:US
Practice Address - Phone:424-999-5677
Practice Address - Fax:213-260-9356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty