Organization
SOURCE SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TIMOTHY T DAVIS MD (OWNER)
(310) 574-2777
Entity
Organization
Contact information
Practice address
2801 WILSHIRE BLVD, SANTA MONICA, CA 90403-4801
(310) 574-2777
(310) 315-4968
Mailing address
1112 MONTANA AVE, SUITE 900, SANTA MONICA, CA 90403-1652
(310) 574-2777
(310) 315-4968
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
03/14/2017
Last updated
01/21/2020
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