Healthcare Provider Details

I. General information

NPI: 1386186781
Provider Name (Legal Business Name): BUENA VISTA SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2016
Last Update Date: 04/11/2025
Certification Date: 04/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1762 MANHATTAN BEACH BLVD STE 202
MANHATTAN BEACH CA
90266-6220
US

IV. Provider business mailing address

121 GRAY AVE SUITE 200
SANTA BARBARA CA
93101-1800
US

V. Phone/Fax

Practice location:
  • Phone: 888-282-7472
  • Fax:
Mailing address:
  • Phone:
  • 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: MATTHEW ENNA
Title or Position: OWNER
Credential:
Phone: 310-858-3880