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General NPI Number Information
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NPI Number | 1427577907
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Entity Type | Organization
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Legal Business Name | ADVANCE OC SURGICAL INC.
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Dates
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Enumeration Date | 09/15/2017
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Last Update Date | 09/15/2017
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Provider Practice Location Address
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Address Line | 3500 S. BRISTOL ST. SUITE 200
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City | SANTA ANA
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State | CA
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Zip | 92704
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Country | US
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Telephone | 714-557-0777
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Fax | 714-557-0709
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Provider Business Mailing Address
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Address Line | 3500 S. BRISTOL ST. SUITE 200
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City | SANTA ANA
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State | CA
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Zip | 92704
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Country | US
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Telephone | 714-557-0777
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Fax | 714-557-0709
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Authorized Official
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Title or Position | CEO
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Name | MR. TIMOTHY OMID ROHAM
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Credential | D.O.
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Telephone | 949-212-7133
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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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