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General NPI Number Information
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NPI Number | 1376595421
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Entity Type | Organization
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Legal Business Name | OTAY LAKES SURGERY CENTER, LLC
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 955 LANE AVE SUITE 100
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City | CHULA VISTA
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State | CA
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Zip | 91914-3501
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Country | US
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Telephone | 619-754-2260
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Fax | 619-754-2261
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Provider Business Mailing Address
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Address Line | 955 LANE AVE SUITE 100
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City | CHULA VISTA
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State | CA
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Zip | 91914-3501
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Country | US
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Telephone | 619-754-2260
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Fax | 619-754-2261
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Authorized Official
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Title or Position | VP OPERATIONS AND ADMINISTRATION
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Name | MR. GARY KURTH
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Credential |
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Telephone | 619-754-2260
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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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