Organization
PROVIDENCE SPECIALTY SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMSHID SHADJAREH (CHAIRMAN, GOVERNING BODY)
(714) 204-0444
Entity
Organization
Contact information
Practice address
1310 W STEWART DR STE 310, ORANGE, CA 92868-3838
(714) 204-0444
Mailing address
1310 W STEWART DR STE 310, ORANGE, CA 92868-3838
(714) 204-0444
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
04/28/2023
Last updated
04/28/2023
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