Provider Demographics
NPI:1861733974
Name:UNITED CALIFORNIA SURGICAL FORUM INC.
Entity type:Organization
Organization Name:UNITED CALIFORNIA SURGICAL FORUM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RAME
Authorized Official - Middle Name:D
Authorized Official - Last Name:IBERDEMAJ
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:559-673-5657
Mailing Address - Street 1:1000 E ALMOND AVE # 3A
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5693
Mailing Address - Country:US
Mailing Address - Phone:559-673-5657
Mailing Address - Fax:559-549-9736
Practice Address - Street 1:1000 E ALMOND AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-5693
Practice Address - Country:US
Practice Address - Phone:559-673-5657
Practice Address - Fax:559-549-9736
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-14
Last Update Date:2013-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1120012086S0129X, 208G00000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty