Healthcare Provider Details

I. General information

NPI: 1497705883
Provider Name (Legal Business Name): MISSION AMBULATORY SURGICENTER LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 05/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26730 CROWN VALLEY PKWY SUITE 100
MISSION VIEJO CA
92691-6364
US

IV. Provider business mailing address

26730 CROWN VALLEY PKWY SUITE 100
MISSION VIEJO CA
92691-6364
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-2201
  • Fax: 949-364-5372
Mailing address:
  • Phone: 949-364-2201
  • Fax: 949-364-5372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number060000265
License Number StateCA

VIII. Authorized Official

Name: MRS. RAMONA L DWIGHT
Title or Position: BUSINESS MANAGER
Credential:
Phone: 949-364-2201