Healthcare Provider Details

I. General information

NPI: 1023504206
Provider Name (Legal Business Name): PLACENTIA SURGICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2018
Last Update Date: 07/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 E YORBA LINDA BLVD STE 200A
PLACENTIA CA
92870-3728
US

IV. Provider business mailing address

1041 E YORBA LINDA BLVD STE 200A
PLACENTIA CA
92870-3728
US

V. Phone/Fax

Practice location:
  • Phone: 714-223-9000
  • Fax: 714-223-9002
Mailing address:
  • Phone: 714-223-9000
  • Fax: 714-223-9002

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: MRS. DENISE BALKCOM
Title or Position: ADMINISTRATOR
Credential:
Phone: 888-268-8607