Healthcare Provider Details

I. General information

NPI: 1023421146
Provider Name (Legal Business Name): PRIME SURGICAL CTR OF FOOTHILL RANCH, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2014
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27462 PORTOLA PKWY SUITE 100
FOOTHILL RANCH CA
92610-2838
US

IV. Provider business mailing address

550 N BRAND BLVD STE 900
GLENDALE CA
91203-4721
US

V. Phone/Fax

Practice location:
  • Phone: 949-900-1340
  • Fax:
Mailing address:
  • Phone: 818-937-9969
  • Fax: 818-937-9968

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: CAROLINE SINGER
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CASC
Phone: 818-937-9969