Healthcare Provider Details

I. General information

NPI: 1881170108
Provider Name (Legal Business Name): NEWPORT COAST SURGICAL CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 08/27/2024
Certification Date: 08/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 BIRCH ST STE A
NEWPORT BEACH CA
92660-1928
US

IV. Provider business mailing address

2711 N SEPULVEDA BLVD # 223
MANHATTAN BEACH CA
90266-2725
US

V. Phone/Fax

Practice location:
  • Phone: 661-472-4177
  • Fax:
Mailing address:
  • Phone: 661-472-4177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ELENA SERDA
Title or Position: OWNER
Credential:
Phone: 661-472-4177