Healthcare Provider Details

I. General information

NPI: 1396352944
Provider Name (Legal Business Name): IRVINE SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2020
Last Update Date: 09/28/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17624 REDHILL AVE STE B
IRVINE CA
92614
US

IV. Provider business mailing address

5862 BOLSA AVE STE 105
HUNTINGTON BEACH CA
92649-1169
US

V. Phone/Fax

Practice location:
  • Phone: 480-626-1746
  • Fax: 714-894-3083
Mailing address:
  • Phone:
  • Fax: 714-894-3083

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: MATTHEW GRIFFITH
Title or Position: OWNER
Credential:
Phone: 480-626-1746