Healthcare Provider Details

I. General information

NPI: 1366635294
Provider Name (Legal Business Name): BODY BY FISHER SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2007
Last Update Date: 08/23/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17491 BASTANCHURY RD
YORBA LINDA CA
92886-1801
US

IV. Provider business mailing address

17491 BASTANCHURY RD
YORBA LINDA CA
92886-1801
US

V. Phone/Fax

Practice location:
  • Phone: 714-773-9010
  • Fax: 714-528-7087
Mailing address:
  • Phone: 714-773-9010
  • Fax: 714-528-7087

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: DR. JOHN BRADFORD FISHER
Title or Position: DIRECTOR
Credential: M.D.
Phone: 714-773-9010