Healthcare Provider Details

I. General information

NPI: 1215220215
Provider Name (Legal Business Name): NORTH PARK SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 05/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N TUSTIN AVE STE 155
SANTA ANA CA
92705-3594
US

IV. Provider business mailing address

1200 N TUSTIN AVE STE 155
SANTA ANA CA
92705-3594
US

V. Phone/Fax

Practice location:
  • Phone: 714-543-3800
  • Fax: 714-459-8280
Mailing address:
  • Phone: 714-543-3800
  • Fax: 714-459-8280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MISS LORENZA VALDIVIAS
Title or Position: ADMINISTRATOR
Credential:
Phone: 714-543-3800