Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Premier Surgical Pavilion of La

Organization Ambulatory Surgical Clinic/Center · NPI 1114589793

Premier Surgical Pavilion of La is an Ambulatory Surgical Clinic/Center in Los Angeles, California. Registered with an NPI since 2019.

In the registry since
2019

Practice location Address checks out

11661 San Vicente Blvd
Los Angeles, CA 90049-5103
Phone: (212) 223-0716
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Ambulatory Surgical Clinic/Center (primary) Taxonomy 261QA1903X

Record details

NPI number1114589793
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Michael Jones — Medical Director · (212) 223-0716
NPI enumeratedJuly 3, 2019
Last updated in NPPESJuly 3, 2019
Mailing address115 E 39th St, New York, NY 10016-0943

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