Healthcare Provider Details

I. General information

NPI: 1194770727
Provider Name (Legal Business Name): POWAY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15525 POMERADO RD SUITE E2
POWAY CA
92064-2435
US

IV. Provider business mailing address

15525 POMERADO RD SUITE E2
POWAY CA
92064-2435
US

V. Phone/Fax

Practice location:
  • Phone: 858-521-0003
  • Fax: 858-521-0144
Mailing address:
  • Phone: 858-521-0003
  • Fax: 858-521-0144

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateCA

VIII. Authorized Official

Name: MS. LAURA JEAN HARDING
Title or Position: MANAGER
Credential:
Phone: 858-521-0444