1992840722 NPI number — NEWPORT BEACH LIDO SURGERY CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992840722 NPI number — NEWPORT BEACH LIDO SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEWPORT BEACH LIDO SURGERY CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
HOAG OUTPATIENT SURGERY CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992840722
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
351 HOSPITAL RD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
NEWPORT BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92663-3509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
949-642-3263
Provider Business Mailing Address Fax Number:
949-642-2034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
351 HOSPITAL RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92663-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-642-3263
Provider Business Practice Location Address Fax Number:
949-642-2034
Provider Enumeration Date:
02/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KLEINBART
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
MEMBER, GOVERNING BOARD
Authorized Official Telephone Number:
949-764-8128

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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