Healthcare Provider Details

I. General information

NPI: 1356395354
Provider Name (Legal Business Name): NEWPORT COAST OUTPATIENT SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 NEWPORT CENTER DR SUITE 300
NEWPORT BEACH CA
92660-7601
US

IV. Provider business mailing address

400 NEWPORT CENTER DR SUITE 300
NEWPORT BEACH CA
92660-7601
US

V. Phone/Fax

Practice location:
  • Phone: 949-644-1240
  • Fax: 949-644-9274
Mailing address:
  • Phone: 949-644-1240
  • Fax: 949-644-9274

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: DR. JON M GRAZER
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 949-644-1240