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General NPI Number Information
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NPI Number | 1104985910
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Entity Type | Organization
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Legal Business Name | FOOTHILL SURGICAL INSTITUTE, LLC
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Dates
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Enumeration Date | 12/07/2006
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Last Update Date | 09/14/2023
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Provider Practice Location Address
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Address Line | 29300 PORTOLA PKWY SUITE A
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City | LAKE FOREST
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State | CA
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Zip | 92630-8718
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Country | US
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Telephone | 949-367-1006
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Fax |
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Provider Business Mailing Address
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Address Line | 29300 PORTOLA PKWY STE A
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City | LAKE FOREST
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State | CA
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Zip | 92630-8741
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Country | US
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Telephone | 949-367-1006
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | NAZLI AREFKIA
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Credential |
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Telephone | 949-510-0951
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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 |
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