Organization
PREMIER SURGICAL PAVILION OF LA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL EUGENE JONES MD (MEDICAL DIRECTOR)
(212) 223-0716
Entity
Organization
Contact information
Practice address
11661 SAN VICENTE BLVD, LOS ANGELES, CA 90049-5103
(212) 223-0716
Mailing address
115 E 39TH ST, NEW YORK, NY 10016-0943
(212) 223-0716
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C53266
MEDICAL LICENSE
CA
Enumeration date
07/03/2019
Last updated
07/03/2019
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