# LAKE PLEASANT SURGICAL CENTER LLC

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

## Provider details

- **NPI number:** 1902403736
- **Authorized official:** THOMAS MOSHIRI (MANAGER)
- **Authorized official phone:** (602) 441-3573

## Contact information

- **Practice address:** 15601 N 28TH AVE STE 101, PHOENIX, AZ 85053-4061
- **Practice address phone:** (602) 237-6340
- **Mailing address:** 10810 N TATUM BLVD STE 102-855, PHOENIX, AZ 85028-6055

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 10/05/2020
- **Last updated:** 02/24/2022