Healthcare Provider Details

I. General information

NPI: 1497898647
Provider Name (Legal Business Name): BREA SURGICAL CENTER, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 01/20/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 W CENTRAL AVE SUITE 101
BREA CA
92821-3013
US

IV. Provider business mailing address

400 W CENTRAL AVE SUITE 101
BREA CA
92821-3013
US

V. Phone/Fax

Practice location:
  • Phone: 714-671-3033
  • Fax: 714-671-1231
Mailing address:
  • Phone: 714-671-3033
  • Fax: 714-671-1231

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberC2037386
License Number StateCA

VIII. Authorized Official

Name: DR. FREDERIC H CORBIN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-671-3033