Healthcare Provider Details

I. General information

NPI: 1922128792
Provider Name (Legal Business Name): LA REGIONAL SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 07/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W LA VETA AVE STE. 100
ORANGE CA
92866-2607
US

IV. Provider business mailing address

302 W LA VETA AVE SUITE 100
ORANGE CA
92866-2607
US

V. Phone/Fax

Practice location:
  • Phone: 714-516-2600
  • Fax:
Mailing address:
  • Phone: 714-516-2605
  • 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: DR. ISAAC VERBUKH
Title or Position: OWNER
Credential: M.D.
Phone: 310-301-8329