Organization
BROCKTON ENDOSCOPY SURGERY CENTER LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VINOD MISHRA M.D. (MEDICAL DIRECTOR)
(951) 788-4400
Entity
Organization
Contact information
Practice address
6958 BROCKTON AVE, SUITE 100, RIVERSIDE, CA 92506-3829
(951) 788-4400
Mailing address
6958 BROCKTON AVE, SUITE 100, RIVERSIDE, CA 92506-3829
(951) 788-4400
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
CA
Other
Enumeration date
05/03/2007
Last updated
10/07/2015
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