Provider Demographics
NPI:1992573513
Name:CULL CANYON SURGERY CENTER LLC
Entity type:Organization
Organization Name:CULL CANYON SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MISS
Authorized Official - First Name:PELIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:310-382-7539
Mailing Address - Street 1:425 15TH ST UNIT 3195
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-7316
Mailing Address - Country:US
Mailing Address - Phone:818-855-1507
Mailing Address - Fax:
Practice Address - Street 1:20998 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5918
Practice Address - Country:US
Practice Address - Phone:818-855-1507
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-13
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical