Healthcare Provider Details

I. General information

NPI: 1013165380
Provider Name (Legal Business Name): NORTH TUSTIN SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2008
Last Update Date: 03/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N TUSTIN AVE SUITE 155
SANTA ANA CA
92705-3508
US

IV. Provider business mailing address

1200 N TUSTIN AVE SUITE 155
SANTA ANA CA
92705-3508
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-3800
  • Fax: 714-543-6038
Mailing address:
  • Phone: 714-543-3800
  • Fax: 714-543-6038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. EDUARDO ERNESTO ANGUIZOLA
Title or Position: OWNER
Credential: M.D.
Phone: 714-664-0905