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General NPI Number Information
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NPI Number | 1548897697
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Entity Type | Organization
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Legal Business Name | CIRCLE CITY SURGERY CENTER
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Dates
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Enumeration Date | 03/26/2020
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Last Update Date | 03/26/2020
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Provider Practice Location Address
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Address Line | 1810 FULLERTON AVE STE 103
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City | CORONA
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State | CA
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Zip | 92881-3103
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Country | US
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Telephone | 949-416-1070
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Fax |
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Provider Business Mailing Address
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Address Line | 31569 CANYON ESTATES DR STE 135
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-0472
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Country | US
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Telephone | 951-734-7246
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | KHURAM SIAL
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Credential | MD
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Telephone | 949-416-1070
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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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