Healthcare Provider Details

I. General information

NPI: 1700985397
Provider Name (Legal Business Name): SPECIALISTS SURGERY CENTER OF DEL MAR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12264 EL CAMINO REAL SUITE 55
SAN DIEGO CA
92130
US

IV. Provider business mailing address

12264 EL CAMINO REAL SUITE 55
SAN DIEGO CA
92130
US

V. Phone/Fax

Practice location:
  • Phone: 858-755-3937
  • Fax: 858-755-0060
Mailing address:
  • Phone: 858-755-3937
  • Fax: 858-755-0060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberG63727
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GLENN B. COOK
Title or Position: PRESIDENT
Credential: MD
Phone: 858-755-3937