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General NPI Number Information
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NPI Number | 1023250438
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Entity Type | Organization
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Legal Business Name | OC MULTISPECIALTY SURGERY CENTER LP
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Dates
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Enumeration Date | 03/31/2009
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Last Update Date | 02/24/2015
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Provider Practice Location Address
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Address Line | 14642 NEWPORT AVE SUITE 100
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City | TUSTIN
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State | CA
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Zip | 92780
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Country | US
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Telephone | 714-505-5005
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Fax | 714-505-5009
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Provider Business Mailing Address
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Address Line | 4333 ADMIRALTY WAY WEST HELIX 9
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City | MARINA DEL REY
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State | CA
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Zip | 90292-5469
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Country | US
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Telephone | 310-827-2549
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Fax | 424-270-9451
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Authorized Official
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Title or Position | OWNER
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Name | DR. ISAAC VERBUKH
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Credential | M.D.
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Telephone | 310-827-2549
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | CA
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