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General NPI Number Information
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NPI Number | 1669405684
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Entity Type | Organization
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Legal Business Name | PACIFICOAST AMBULATORY SURGICENTER, LLC.
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 12/15/2015
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Provider Practice Location Address
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Address Line | 665 CAMINO DE LOS MARES SUITE 100C
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2859
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Country | US
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Telephone | 949-481-7760
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Fax |
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Provider Business Mailing Address
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Address Line | 665 CAMINO DE LOS MARES SUITE 100C
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City | SAN CLEMENTE
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State | CA
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Zip | 92673-2859
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | GENERAL MANAGER
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Name | CHRIS GANGNES
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Credential |
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Telephone | 949-276-4141
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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 | 18448
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License Number State | CA
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