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NPI Code Detail

MEDICARE: NEWPORT BEACH LIDO SURGERY CENTER, LLC

MEDICARE: NEWPORT BEACH LIDO SURGERY CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1992840722
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEWPORT BEACH LIDO SURGERY CENTER, LLC
Provider Business Mailing Address
First Line : 351 HOSPITAL RD
Second Line : SUITE 110
City : NEWPORT BEACH
State : CA
Zip : 92663-3509
Country : US
Telephone Number : 949-642-3263
Fax Number : 949-642-2034
Provider Business Practice Location Address
First Line : 351 HOSPITAL RD
Second Line : SUITE 110
City : NEWPORT BEACH
State : CA
Zip : 92663-3509
Country : US
Telephone Number : 949-642-3263
Fax Number : 949-642-2034
Authorized Official
Title or Position : MEMBER, GOVERNING BOARD
Name : MARTIN KLEINBART
Credential : DPM
Telephone Number : 949-764-8128
Provider Enumeration Date : 02/20/2007
Last Update Date : 08/22/2020

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Directions to “NEWPORT BEACH LIDO SURGERY CENTER, LLC ” Practice Location

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