Healthcare Provider Details

I. General information

NPI: 1083886394
Provider Name (Legal Business Name): CALIFORNIA SURGICAL INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2008
Last Update Date: 03/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E BIRCH ST SUITE 350
BREA CA
92821-5800
US

IV. Provider business mailing address

910 E BIRCH ST SUITE 350
BREA CA
92821-5800
US

V. Phone/Fax

Practice location:
  • Phone: 714-990-9012
  • Fax: 714-990-9015
Mailing address:
  • Phone: 714-990-9012
  • Fax: 714-990-9015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA75774
License Number StateCA

VIII. Authorized Official

Name: MR. JAVIER ERIVES
Title or Position: SITE DIRECTOR
Credential:
Phone: 866-372-3288