# CENTENNIAL SPECIALTY SURGERY CENTER INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043560295
- **Authorized official:** DR. DANIEL P TAHERI M.D. (OWNER)
- **Authorized official phone:** (310) 993-8994

## Contact information

- **Practice address:** 5550 PAINTED MIRAGE RD, SUITE 100, LAS VEGAS, NV 89149-4581
- **Practice address phone:** (310) 993-8994
- **Mailing address:** PO BOX 16297, BEVERLY HILLS, CA 90209-2297
- **Mailing address phone:** (800) 991-6448

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 20120078160-37 | NV | Yes |

## Other

- **Enumeration date:** 09/14/2012
- **Last updated:** 08/07/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 20120078160-37 | CORPORATION ID | NV |