Healthcare Provider Details

I. General information

NPI: 1215079868
Provider Name (Legal Business Name): CORONA SURGERY INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1810 FULLERTON AVE SUITE 103
CORONA CA
92881-3103
US

IV. Provider business mailing address

1810 FULLERTON AVE SUITE 103
CORONA CA
92881-3103
US

V. Phone/Fax

Practice location:
  • Phone: 951-738-2229
  • Fax: 951-738-2222
Mailing address:
  • Phone: 951-738-2229
  • Fax: 951-738-2222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAUREN PARROTT
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-726-0682