Healthcare Provider Details

I. General information

NPI: 1699711556
Provider Name (Legal Business Name): ESCNC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1386 LEAD HILL BLVD STE 130
ROSEVILLE CA
95661-2936
US

IV. Provider business mailing address

75 ENTERPRISE STE 200
ALISO VIEJO CA
92656-2626
US

V. Phone/Fax

Practice location:
  • Phone: 916-527-8921
  • Fax: 916-238-6209
Mailing address:
  • Phone: 877-455-9942
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number030000363
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number030000363
License Number StateCA

VIII. Authorized Official

Name: DR. MUJAHID HINES
Title or Position: OWNER
Credential: MD
Phone: 916-723-7400