Organization
CENTENNIAL SPECIALTY SURGERY CENTER INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL P TAHERI M.D. (OWNER)
(310) 993-8994
Entity
Organization
Contact information
Practice address
5550 PAINTED MIRAGE RD, SUITE 100, LAS VEGAS, NV 89149-4581
(310) 993-8994
Mailing address
PO BOX 16297, BEVERLY HILLS, CA 90209-2297
(800) 991-6448
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
20120078160-37
NV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20120078160-37
CORPORATION ID
NV
Enumeration date
09/14/2012
Last updated
08/07/2020
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