Healthcare Provider Details

I. General information

NPI: 1477527398
Provider Name (Legal Business Name): TEMECULA CA ENDOSCOPY ASC LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 09/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25150 HANCOCK AVE SUITE 208
MURRIETA CA
92562-5987
US

IV. Provider business mailing address

25150 HANCOCK AVE SUITE 208
MURRIETA CA
92562-5987
US

V. Phone/Fax

Practice location:
  • Phone: 951-698-8805
  • Fax: 951-698-8898
Mailing address:
  • Phone: 951-698-8805
  • Fax: 951-698-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number250000810
License Number StateCA

VIII. Authorized Official

Name: MR. PHILLIP A CLENDENIN
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283