Healthcare Provider Details

I. General information

NPI: 1124068549
Provider Name (Legal Business Name): CROWN VALLEY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26921 CROWN VALLEY PKWY 110
MISSION VIEJO CA
92691-6501
US

IV. Provider business mailing address

26921 CROWN VALLEY PKWY 110
MISSION VIEJO CA
92691-6501
US

V. Phone/Fax

Practice location:
  • Phone: 949-348-7252
  • Fax: 949-348-7675
Mailing address:
  • Phone: 949-348-7252
  • Fax: 949-348-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MR. WILLIAM JAMES GRAY
Title or Position: ADMIMISTRATOR
Credential: RN
Phone: 949-348-7252