Healthcare Provider Details

I. General information

NPI: 1609108083
Provider Name (Legal Business Name): GENESIS AMBULATORY SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2010
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

PO BOX 2393
ORANGE CA
92859-0393
US

V. Phone/Fax

Practice location:
  • Phone: 949-837-3000
  • Fax: 949-259-6978
Mailing address:
  • Phone: 949-837-3000
  • Fax: 949-259-6978

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: YASSER HILMY SALEM
Title or Position: CEO
Credential: MD
Phone: 714-545-5200