Provider Demographics
NPI:1730454737
Name:SAN DIMAS SURGICAL MEDICAL CENTER
Entity type:Organization
Organization Name:SAN DIMAS SURGICAL MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MINEHART
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:818-784-3125
Mailing Address - Street 1:16250 VENTURA BLVD STE 165
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2273
Mailing Address - Country:US
Mailing Address - Phone:818-784-3125
Mailing Address - Fax:818-784-3126
Practice Address - Street 1:1359 W ARROW HWY
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-2330
Practice Address - Country:US
Practice Address - Phone:818-784-3125
Practice Address - Fax:818-784-3126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-09
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical