Healthcare Provider Details

I. General information

NPI: 1437082088
Provider Name (Legal Business Name): ORANGE COUNTY UROLOGY SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/04/2026
Last Update Date: 06/04/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18 ENDEAVOR STE 102
IRVINE CA
92618-3180
US

IV. Provider business mailing address

23961 CALLE DE MAGDALENA SUITE 500
LAGUNA HILLS CA
92653
US

V. Phone/Fax

Practice location:
  • Phone: 949-630-0621
  • Fax:
Mailing address:
  • Phone: 949-630-0621
  • Fax:

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: TIFFANY THALHAMER
Title or Position: DIRECTOR OF NURSING
Credential: RN
Phone: 949-805-1253