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General NPI Number Information
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NPI Number | 1679528772
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Entity Type | Organization
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Legal Business Name | ST JOSEPH SURGERY & LASER CENTER INC
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 10/13/2008
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Provider Practice Location Address
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Address Line | 436 S GLASSELL ST
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City | ORANGE
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State | CA
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Zip | 92866-1906
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Country | US
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Telephone | 714-633-9566
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Fax | 714-633-7470
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Provider Business Mailing Address
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Address Line | 436 S GLASSELL ST
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City | ORANGE
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State | CA
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Zip | 92866-1906
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Country | US
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Telephone | 714-633-9566
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Fax | 714-633-7470
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Authorized Official
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Title or Position | CEO
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Name | MRS. KATHLEEN RUPER
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Credential |
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Telephone | 714-633-6060
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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 | 060000429
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License Number State | CA
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