# SAN VICENTE SURGERY CENTER, LLC

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

## Provider details

- **NPI number:** 1932275054
- **Authorized official:** DR. STEVEN N BROURMAN M.D. (GOVERNING BODY)
- **Authorized official phone:** (310) 289-8600

## Contact information

- **Practice address:** 11645 WILSHIRE BLVD STE 987, LOS ANGELES, CA 90025-6814
- **Practice address phone:** (310) 289-8600
- **Mailing address:** 11645 WILSHIRE BLVD STE 987, LOS ANGELES, CA 90025-6814
- **Mailing address phone:** (310) 289-8600

## Taxonomy

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

## Other

- **Enumeration date:** 11/28/2006
- **Last updated:** 06/02/2020