Healthcare Provider Details

I. General information

NPI: 1710801022
Provider Name (Legal Business Name): BACK BAY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 IRVINE AVE
NEWPORT BEACH CA
92660-3114
US

IV. Provider business mailing address

3440 IRVINE AVE
NEWPORT BEACH CA
92660-3114
US

V. Phone/Fax

Practice location:
  • Phone: 949-432-4730
  • Fax:
Mailing address:
  • Phone: 949-432-4730
  • Fax:

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: ANA QUINTANILHA
Title or Position: CONSULTANT
Credential:
Phone: 424-744-0793