Healthcare Provider Details

I. General information

NPI: 1689175101
Provider Name (Legal Business Name): CALIFORNIA SURGICAL P. C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 02/21/2018
Certification Date: CALIFORNIA SURGICAL P. C. 17672 BEACH BLVD STE B HUNTINGTON BEACH CA 92647 17672 BEACH BLVD STE B HUNTINGTON BEACH CA 92647
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17672 BEACH BLVD STE B
HUNTINGTON BEACH CA
92647-6836
US

IV. Provider business mailing address

17672 BEACH BLVD STE B
HUNTINGTON BEACH CA
92647-6836
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 TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical
License Number
License Number State

VIII. Authorized Official

Name: CRYSTAL COTA
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-848-5555