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General NPI Number Information
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NPI Number | 1407086044
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Entity Type | Organization
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Legal Business Name | ORANGE COAST SURGERY CENTER
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Dates
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Enumeration Date | 07/16/2009
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 1000 S ANAHEIM BLVD SUITE 300
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City | ANAHEIM
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State | CA
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Zip | 92805-5804
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Country | US
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Telephone | 714-399-0046
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Fax | 714-399-0049
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Provider Business Mailing Address
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Address Line | 1000 S ANAHEIM BLVD STE 300
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City | ANAHEIM
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State | CA
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Zip | 92805-5804
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Country | US
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Telephone | 714-399-0046
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Fax | 714-399-0049
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Authorized Official
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Title or Position | OWNER/CEO
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Name | MR. KRISHNA PRASAD SURAPANENI
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Credential | M.D.
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Telephone | 714-399-0046
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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 | A49872
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License Number State | CA
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