Healthcare Provider Details

I. General information

NPI: 1982183299
Provider Name (Legal Business Name): COSTA MESA SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 08/08/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 PAULARINO AVE STE 100
COSTA MESA CA
92626-6917
US

IV. Provider business mailing address

3680 WILSHIRE BLVD STE 206
LOS ANGELES CA
90010-2714
US

V. Phone/Fax

Practice location:
  • Phone: 213-383-4800
  • Fax:
Mailing address:
  • Phone: 213-383-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER G LEE
Title or Position: OWNER
Credential: MD
Phone: 213-383-4800