PREMIER SURGICAL PAVILION OF LA
NPI 1114589793
Clinic/Center - Ambulatory Surgical in Los Angeles, CA
About Premier Surgical Pavilion Of La NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
PREMIER SURGICAL PAVILION OF LA (NPI 1114589793) is a healthcare organization registered as an ambulatory surgical in Los Angeles, California and active in the NPI registry since July 2019. The organization holds a CLIA Waiver certificate valid through October 1, 2026 and lists Michael Eugene Jones, Medical Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D2194751
Premier Surgical Pavilion Of Los Angeles · Los Angeles, CAOther Providers at the Same Location NPPES 5
Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.
LOS ANGELES, CA 90049
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Premier Surgical Pavilion Of La's NPI number?
The NPI number for Premier Surgical Pavilion Of La is 1114589793. It was assigned to this organization in the NPPES registry on July 3, 2019.
Where is Premier Surgical Pavilion Of La located?
Premier Surgical Pavilion Of La is located at 11661 San Vicente Blvd, Los Angeles, CA 90049. The listed phone number is (212) 223-0716.
What is Premier Surgical Pavilion Of La's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.
Does Premier Surgical Pavilion Of La hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2194751) is associated with this NPI, valid through October 1, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Premier Surgical Pavilion Of La was last updated on July 3, 2019. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 7 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Premier Surgical Pavilion Of La · NPI 1114589793
Ambulatory Surgical organization in Los Angeles, California. Organization record, active in the CMS NPPES registry since July 3, 2019.
## Identity
- **NPI:** 1114589793 (Entity type: Organization)
- **Enumerated:** July 3, 2019
- **Primary specialty:** Clinic/Center - Ambulatory Surgical · taxonomy 261QA1903X
- **Organization subpart:** No
- **Authorized official:** Michael Jones, MEDICAL DIRECTOR
## Practice location
- **Address:** 11661 SAN VICENTE BLVD, Los Angeles, CA 90049-5103
- **Phone:** (212) 223-0716
## Record status
- **NPPES last updated:** July 3, 2019
- **Other identifiers:** Other C53266 (CA)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1114589793) · Data from the CMS NPPES public registry.