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General NPI Number Information
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NPI Number | 1992846299
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Entity Type | Organization
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Legal Business Name | LIDO SURGICAL INSTITUTE, LTD.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 07/28/2010
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Provider Practice Location Address
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Address Line | 320 SUPERIOR AVE STE 180
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-2782
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Country | US
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Telephone | 949-645-9995
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Fax |
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Provider Business Mailing Address
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Address Line | 320 SUPERIOR AVE STE 180
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City | NEWPORT BEACH
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State | CA
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Zip | 92663-2782
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Country | US
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Telephone | 949-645-9995
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. AMY BANDY
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Credential | D.O.
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Telephone | 949-645-9995
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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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