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General NPI Number Information
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NPI Number | 1366044596
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Entity Type | Organization
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Legal Business Name | PEGASUS SURGERY CENTER LLC
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Dates
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Enumeration Date | 11/12/2020
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 20162 SW BIRCH ST STE 100
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-0797
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Country | US
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Telephone | 949-508-1198
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Fax | 949-449-8564
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Provider Business Mailing Address
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Address Line | 13071 SOLINDA
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City | TUSTIN
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State | CA
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Zip | 92782-8709
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Country | US
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Telephone | 661-965-5020
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MR. MICHAEL TASSOS
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Credential | CPA
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Telephone | 661-965-5020
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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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