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General NPI Number Information
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NPI Number | 1558858597
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Entity Type | Organization
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Legal Business Name | G1 SURGERY CENTER
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Dates
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Enumeration Date | 04/16/2018
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Last Update Date | 08/17/2018
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Provider Practice Location Address
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Address Line | 302 W LA VETA AVE STE 100
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City | ORANGE
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State | CA
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Zip | 92866-2607
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Country | US
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Telephone | 424-220-4400
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Fax | 424-220-8344
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Provider Business Mailing Address
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Address Line | 1431 WARNER AVE STE A
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City | TUSTIN
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State | CA
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Zip | 92780-6444
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Country | US
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Telephone | 424-220-4400
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Fax | 424-220-8344
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Authorized Official
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Title or Position | CEO
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Name | DR. FRANK BERNARD GIACOBETTI
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Credential | MD
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Telephone | 424-220-4400
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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 | CA
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