Healthcare Provider Details

I. General information

NPI: 1043885197
Provider Name (Legal Business Name): SOCAL SURGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 02/05/2025
Certification Date: 02/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4445 MAGNOLIA AVE
RIVERSIDE CA
92501-4135
US

IV. Provider business mailing address

360 E 1ST ST UNIT 770
TUSTIN CA
92780-3211
US

V. Phone/Fax

Practice location:
  • Phone: 714-319-9235
  • Fax:
Mailing address:
  • Phone: 714-319-9235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: JAMES Y LEE
Title or Position: PRESIDENT/PHYSICIAN ASSISTANT
Credential: PA-C
Phone: 714-319-9235