Provider Demographics
NPI:1932440781
Name:SURGICAL AFFILIATES OF CALIFORNIA
Entity type:Organization
Organization Name:SURGICAL AFFILIATES OF CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:FLACKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-441-0400
Mailing Address - Street 1:PO BOX 888095
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90088-8095
Mailing Address - Country:US
Mailing Address - Phone:916-441-0400
Mailing Address - Fax:
Practice Address - Street 1:807 ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:LOS BANOS
Practice Address - State:CA
Practice Address - Zip Code:93635-3512
Practice Address - Country:US
Practice Address - Phone:209-710-8695
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-04
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty