Healthcare Provider Details

I. General information

NPI: 1619299179
Provider Name (Legal Business Name): DOCTORS SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2010
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10900 WARNER AVE SUITE 101-A
FOUNTAIN VALLEY CA
92708-3846
US

IV. Provider business mailing address

10900 WARNER AVE SUITE 101-A
FOUNTAIN VALLEY CA
92708-3846
US

V. Phone/Fax

Practice location:
  • Phone: 714-698-1270
  • Fax: 714-962-7261
Mailing address:
  • Phone: 714-698-1270
  • Fax: 714-962-7261

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. CHRISTIANNE TIEMANN
Title or Position: MEMBER
Credential:
Phone: 714-698-1270