Healthcare Provider Details

I. General information

NPI: 1134737711
Provider Name (Legal Business Name): CALIFORNIA MEDICAL PHYSICIANS AND SURGEONS GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2020
Last Update Date: 11/24/2023
Certification Date: 11/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18080 BEACH BLVD STE 101
HUNTINGTON BEACH CA
92648-1343
US

IV. Provider business mailing address

18080 BEACH BLVD STE 101
HUNTINGTON BEACH CA
92648-1343
US

V. Phone/Fax

Practice location:
  • Phone: 714-848-5555
  • Fax: 888-977-3286
Mailing address:
  • Phone: 714-848-5555
  • Fax: 888-977-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MARC FRIEDMAN
Title or Position: MANAGER
Credential:
Phone: 714-848-5555