Healthcare Provider Details

I. General information

NPI: 1508408725
Provider Name (Legal Business Name): SURF CITY SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2019
Last Update Date: 10/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2414 S FAIRVIEW ST STE 215
SANTA ANA CA
92704-5318
US

IV. Provider business mailing address

2414 S FAIRVIEW ST STE 215
SANTA ANA CA
92704-5318
US

V. Phone/Fax

Practice location:
  • Phone: 657-342-0265
  • Fax: 714-398-8822
Mailing address:
  • Phone: 657-342-0265
  • Fax: 714-398-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL RICHARD PRIESING
Title or Position: OWNER
Credential:
Phone: 657-342-0265