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General NPI Number Information
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NPI Number | 1205077724
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Entity Type | Organization
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Legal Business Name | CORONA SURGERY CENTER, LLC
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 12/29/2010
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Provider Practice Location Address
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Address Line | 1810 FULLERTON AVE SUITE 103
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City | CORONA
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State | CA
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Zip | 92881-3103
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Country | US
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Telephone | 951-738-8383
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Fax | 951-738-8788
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Provider Business Mailing Address
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Address Line | 1810 FULLERTON AVE SUITE 206
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City | CORONA
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State | CA
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Zip | 92881-3103
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Country | US
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Telephone | 951-738-8383
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Fax | 951-738-8788
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAUL A BLACHARSKI
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Credential | MD
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Telephone | 951-738-8383
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | G44451
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License Number State | CA
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