1114678752 NPI number — PACIFIC CREST MULTI SPECIALTY SURGERY, INC.

Table of content: DR. LYNE SOUCY MD, MPH (NPI 1457684185)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114678752 NPI number — PACIFIC CREST MULTI SPECIALTY SURGERY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PACIFIC CREST MULTI SPECIALTY SURGERY, INC.
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:
Provider Other Organization Name Type Code:
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:
1114678752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 PACIFIC COAST HWY STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HERMOSA BEACH
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90254-3259
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-571-9923
Provider Business Mailing Address Fax Number:
310-861-5001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 PACIFIC COAST HWY STE 150
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HERMOSA BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90254-3259
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-571-9923
Provider Business Practice Location Address Fax Number:
310-861-5001
Provider Enumeration Date:
01/14/2022

Additional Information

Authorized Official

Authorized Official Last Name:
BAKIR
Authorized Official First Name:
BRENDAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
310-748-8800

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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