Healthcare Provider Details

I. General information

NPI: 1699777664
Provider Name (Legal Business Name): CHILDREN'S SURGICAL ASSOCIATES, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 W LA VETA AVE STE. 100
ORANGE CA
92868-4231
US

IV. Provider business mailing address

1120 W LA VETA AVE STE. 100
ORANGE CA
92868-4231
US

V. Phone/Fax

Practice location:
  • Phone: 714-571-5000
  • Fax: 714-571-5055
Mailing address:
  • Phone: 714-571-5000
  • Fax: 714-571-5055

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN GERMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 714-289-4704