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General NPI Number Information
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NPI Number | 1871045740
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Entity Type | Organization
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Legal Business Name | ECLIPSESURG INC
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 10/26/2016
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Provider Practice Location Address
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Address Line | 160 BLUE JAY LN
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City | REDLANDS
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State | CA
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Zip | 92374-1651
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Country | US
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Telephone | 269-547-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 160 BLUE JAY LN
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City | REDLANDS
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State | CA
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Zip | 92374-1651
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Country | US
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Telephone | 269-547-0500
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. OLIVIER URAYENEZA
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Credential | MD
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Telephone | 269-547-0500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A133496
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License Number State | CA
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