Healthcare Provider Details

I. General information

NPI: 1407994270
Provider Name (Legal Business Name): FOOTHILL RANCH SURGI-CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26781 PORTOLA PKWY SUITE 4E
FOOTHILL RANCH CA
92610-1758
US

IV. Provider business mailing address

26781 PORTOLA PKWY SUITE 4E
FOOTHILL RANCH CA
92610-1758
US

V. Phone/Fax

Practice location:
  • Phone: 949-837-3000
  • Fax: 949-837-7585
Mailing address:
  • Phone: 949-837-3000
  • Fax: 949-837-7585

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: MRS. VIBHA H PATEL
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-837-3000