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General NPI Number Information
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NPI Number | 1497898647
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Entity Type | Organization
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Legal Business Name | BREA SURGICAL CENTER, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 01/20/2009
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Provider Practice Location Address
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Address Line | 400 W CENTRAL AVE SUITE 101
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City | BREA
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State | CA
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Zip | 92821-3013
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Country | US
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Telephone | 714-671-3033
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Fax | 714-671-1231
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Provider Business Mailing Address
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Address Line | 400 W CENTRAL AVE SUITE 101
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City | BREA
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State | CA
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Zip | 92821-3013
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Country | US
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Telephone | 714-671-3033
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Fax | 714-671-1231
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FREDERIC H CORBIN
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Credential | M.D.
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Telephone | 714-671-3033
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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 | C2037386
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License Number State | CA
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