Healthcare Provider Details

I. General information

NPI: 1376307728
Provider Name (Legal Business Name): MISSION VIEJO ENDOSCOPY PARTNERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 949-706-9900
  • Fax:
Mailing address:
  • Phone: 949-706-9900
  • 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: JAY MCKIM
Title or Position: SVP & CFO
Credential:
Phone: 949-680-3443