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General NPI Number Information
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NPI Number | 1316949415
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Entity Type | Organization
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Legal Business Name | NEWPORT BEACH SURGERY CENTER, LLC
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 361 HOSPITAL ROAD SUITE 124
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City | NEWPORT BEACH
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State | CA
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Zip | 92663
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Country | US
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Telephone | 949-631-0988
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Fax | 949-631-2504
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Provider Business Mailing Address
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Address Line | 361 HOSPITAL ROAD SUITE 124
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City | NEWPORT BEACH
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State | CA
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Zip | 92663
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Country | US
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Telephone | 949-631-0988
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Fax | 949-631-2504
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | LEROY TREY SAMPSON III
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Credential |
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Telephone | 949-631-0988
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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 | 060000339
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License Number State | CA
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