Healthcare Provider Details

I. General information

NPI: 1538159397
Provider Name (Legal Business Name): MAGNOLIA SURGERY CENTER LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14571 MAGNOLIA ST SUITE 107
WESTMINSTER CA
92683-5575
US

IV. Provider business mailing address

14571 MAGNOLIA ST SUITE 107
WESTMINSTER CA
92683-5575
US

V. Phone/Fax

Practice location:
  • Phone: 714-903-9039
  • Fax: 714-903-9439
Mailing address:
  • Phone: 714-903-9039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JENETHA MORAN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 972-763-3893