Provider Demographics
NPI:1902098064
Name:SOUTHERN CALIFORNIA SURGICAL SPECIALISTS, INC
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA SURGICAL SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHIRAZI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-795-0411
Mailing Address - Street 1:50 BELLEFONTAINE ST
Mailing Address - Street 2:SUITE 307
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3132
Mailing Address - Country:US
Mailing Address - Phone:626-795-0411
Mailing Address - Fax:626-795-0080
Practice Address - Street 1:50 BELLEFONTAINE ST
Practice Address - Street 2:SUITE 307
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3132
Practice Address - Country:US
Practice Address - Phone:626-795-0411
Practice Address - Fax:626-795-0080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-13
Last Update Date:2007-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA62828174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20973Medicare PIN