Healthcare Provider Details

I. General information

NPI: 1356480099
Provider Name (Legal Business Name): MEMORIALCARE SURGICAL CENTER AT SADDLEBACK LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 12/19/2023
Certification Date: 12/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24411 HEALTH CENTER DR SUITE 104
LAGUNA HILLS CA
92653-3651
US

IV. Provider business mailing address

24411 HEALTH CENTER DR SUITE 104
LAGUNA HILLS CA
92653-3651
US

V. Phone/Fax

Practice location:
  • Phone: 949-458-5600
  • Fax: 949-458-5621
Mailing address:
  • Phone: 949-458-5600
  • Fax: 949-458-5634

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: LISA MARIE ENGEL
Title or Position: CEO
Credential:
Phone: 949-458-5600