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General NPI Number Information
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NPI Number | 1538596986
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Entity Type | Organization
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Legal Business Name | SIDEOUT SURGERY CENTER INC.
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Dates
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Enumeration Date | 10/01/2013
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Last Update Date | 10/01/2013
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Provider Practice Location Address
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Address Line | 1200 ROSECRANS AVE SUITE 110
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-2462
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Country | US
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Telephone | 714-769-8400
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Fax | 714-482-6127
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Provider Business Mailing Address
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Address Line | 1200 ROSECRANS AVE SUITE 110
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-2462
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Country | US
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Telephone | 714-769-8400
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Fax | 714-482-6127
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Authorized Official
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Title or Position | CEO
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Name | FRANK GIACOBETTI
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Credential | M.D.
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Telephone | 714-769-8400
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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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