Healthcare Provider Details

I. General information

NPI: 1508337742
Provider Name (Legal Business Name): FCOC SURGICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2018
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 ALTON PARKWAY SUITE 201
IRVINE CA
92606-5034
US

IV. Provider business mailing address

13950 MILTON AVE SUITE 402
WESTMINSTER CA
92683-2939
US

V. Phone/Fax

Practice location:
  • Phone: 949-387-3888
  • Fax:
Mailing address:
  • Phone: 714-702-3000
  • Fax: 714-702-3039

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: MIKE RITCHEY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 714-702-3000