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General NPI Number Information
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NPI Number | 1013733641
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Entity Type | Organization
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Legal Business Name | SOCAL ONCOPLASTIC SURGERY PC
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Dates
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Enumeration Date | 11/27/2024
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Last Update Date | 11/27/2024
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Provider Practice Location Address
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Address Line | 601 DOVER DR STE 2
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-5700
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Country | US
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Telephone | 949-229-7971
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Fax | 949-539-0897
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Provider Business Mailing Address
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Address Line | 2661 VISTA ORNADA
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-3555
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Country | US
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Telephone | 949-229-7971
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Fax | 949-539-0897
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Authorized Official
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Title or Position | OWNER
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Name | BROCK LANIER
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Credential | MD
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Telephone | 949-229-7971
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208200000X
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Taxonomy Name | Plastic Surgery Physician
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License Number |
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License Number State |
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