Healthcare Provider Details

I. General information

NPI: 1730466483
Provider Name (Legal Business Name): HOAG OUTPATIENT CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 SUPERIOR AVE SUITE 120
NEWPORT BEACH CA
92663-3657
US

IV. Provider business mailing address

1 HOAG DR PO BOX 6100
NEWPORT BEACH CA
92663-4162
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-7580
  • Fax: 949-764-7585
Mailing address:
  • Phone: 949-764-4624
  • Fax: 949-764-5746

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. ROBERT T BRAITHWAITE
Title or Position: ADMINISTRATOR
Credential:
Phone: 949-517-3141