EVERGREEN SURGICAL CENTER, LLC (NPI# 1497171342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1497171342 |
| Entity Type | Organization |
| Organization Name | EVERGREEN SURGICAL CENTER, LLC |
| Practice Address |
3434 Midway Dr Suite 1008 San Diego CA 92110-4923 |
| Mailing Address |
9461 Charleville Blvd Suite 476 Beverly Hills CA 90212-3017 |
| Practice Telephone | 6192210146 |
| Practice Fax Number | 6192259675 |
| Mailing Telephone | 4242799481 |
| Mailing Fax Number | 4242799482 |
| Enumeration Date | 2014-03-14 |
| Last Update Date | 2014-03-14 |
| Authorized Official Name | MS. MAUREEN JAROSCAK (CHIEF FINANCIAL OFFICER) |
| Authorized Official Telephone | 4242799481 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QA1903X |
Clinic/Center Specialization: Ambulatory Surgical |
Ambulatory Health Care Facilities |
| Street Address |
3434 MIDWAY DR SUITE 1008 |
| City | SAN DIEGO |
| State | CA |
| Zip Code | 92110-4923 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1346241452 | Mark J Tamsen | Emergency Medicine | 3434 Midway Dr, Ste 1002, San Diego, CA 92110-4923 | 2005-08-10 |
| 1114312543 | Kelsey Quinn Gaffney | Physical Therapist | 3434 Midway Dr, Suite 2005a, San Diego, CA 92110-4923 | 2015-04-02 |
| 1720386519 | San Diego Surgery LLC | Specialist | 3434 Midway Dr, 1008, San Diego, CA 92110-4923 | 2011-03-03 |
| 1992003784 | San Diego Ultrasound LLC | Specialist | 3434 Midway Dr, Suite 1008, San Diego, CA 92110-4923 | 2011-03-03 |
| 1346547767 | San Diego Gastroenterology LLC | Specialist | 3434 Midway Dr, Suite 1008, San Diego, CA 92110-4923 | 2011-02-21 |
| 1912239013 | San Diego Ambulatory Surgery Center LLC | Clinic/Center | 3434 Midway Dr, Suite 1006, San Diego, CA 92110-4923 | 2010-02-01 |
| 1073783064 | Richard C. Richley M.d. Inc | Specialist | 3434 Midway Dr, Suite 2001, San Diego, CA 92110-4923 | 2008-03-05 |
| 1518097344 | David M. Kupfer, M.d., Inc. | Plastic Surgery | 3434 Midway Dr, Suite 2004, San Diego, CA 92110-4923 | 2007-03-07 |
| 1760581342 | Outpatient Surgery of Point Loma | Clinic/Center | 3434 Midway Dr, #1006, San Diego, CA 92110-4923 | 2006-09-21 |
| 1851314660 | Richard C Richley | Specialist | 3434 Midway Dr, Suite 2001, San Diego, CA 92110-4923 | 2006-07-25 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669021713 | Ruben Daniel Gutierrez | Marriage & Family Therapist | 4141 Pacific Coast Hwy, San Diego, CA 92110 | 2019-09-10 |
| 1548724081 | Denise Ellen Thompson | Counselor | 3255 Wings Street, San Diego, CA 92110 | 2019-01-29 |
| 1801378716 | Michelle Lisa Jean Crawford | Student in an Organized Health Care Education/Training Program | 3767 Central Avenue, San Diego, CA 92110 | 2018-09-06 |
| 1427539048 | Allison Turrell | Case Manager/Care Coordinator | 4930 Naples Street, San Diego, CA 92110 | 2018-08-22 |
| 1750872768 | Matthew Langworthy | Physical Therapist | 3405 Kenyon St Ste 212, San Diego, CA 92110 | 2018-05-24 |
| 1245748342 | The One Health Boutique, LLC | Chiropractor | 5350 Riley St, San Diego, CA 92110 | 2018-01-11 |
| 1437670155 | Monique A Fernandez | Counselor | 3132 Jefferson Street, San Diego, CA 92110 | 2017-07-03 |
| 1538510391 | Mayu Winters | Registered Nurse | 853 Rosecrans St, San Diego, CA 92110 | 2016-06-23 |
| 1376998864 | Briniti Ichull | Specialist | 3941 Kurtz St, San Diego, CA 92110 | 2016-05-03 |
| 1912352576 | Healthcare Services, Inc. | Substance Abuse Rehabilitation Facility | 3880 Rosecrans Street, San Diego, CA 92110 | 2016-05-02 |
| Find all providers in zip 92110 | ||||
| Taxonomy Code | 261QA1903X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Ambulatory Surgical |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275006173 | Balboa Surgical Institute, Inc. | Clinic/Center | 7625 Mesa College Drive, Suite 315a, San Diego, CA 92111-5343 | 2019-01-03 |
| 1598276404 | Balboa Nephrology Medical Group,inc. | Clinic/Center | 6402 El Cajon Blvd Ste 100, San Diego, CA 92115-2645 | 2017-10-18 |
| 1316462377 | Ucsd Surgical Center of San Diego, LLC | Clinic/Center | 4910 Directors Pl Ste 100, San Diego, CA 92121-3814 | 2017-08-10 |
| 1710325220 | Carmel Valley Surgical Center | Clinic/Center | 11943 El Camino Real, Suite 100, San Diego, CA 92130-2597 | 2013-06-06 |
| 1346515095 | Medical Acadamy of Hawaii and Anatomical Learning Orginization | Clinic/Center | 5286 Eastgate Mall, San Diego, CA 92121-2815 | 2012-03-14 |
| 1245534460 | The Hilinski Ambulatory Surgery Center | Clinic/Center | 3720 4th Avenue, San Diego, CA 92103 | 2011-01-03 |
| 1538463153 | La Jolla Surgery Center | Clinic/Center | 4510 Executive Dr Ste 200a, San Diego, CA 92121-3023 | 2010-12-23 |
| 1922324177 | Surgical Center of San Diego, LLC | Clinic/Center | 4910 Directors Place, Suite 100, San Diego, CA 92121-3814 | 2010-04-13 |
| 1194968677 | Professional Surgicenter, Inc | Clinic/Center | 4510 Executive Dr Ste 105a, San Diego, CA 92121-3022 | 2009-04-13 |
| 1578729539 | The Reservoir Physicans Surgery Center, LLC | Clinic/Center | 6716 Alvarado Rd, San Diego, CA 92120 | 2008-07-30 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.