1154600377 NPI number — DISC SURGERY CENTER OF NEWPORT BEACH

Table of content: (NPI 1154600377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154600377 NPI number — DISC SURGERY CENTER OF NEWPORT BEACH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DISC SURGERY CENTER OF NEWPORT BEACH
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:
1154600377
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13160 MINDANAO WAY
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
MARINA DEL REY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90292-6358
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-574-0450
Provider Business Mailing Address Fax Number:
310-574-0371

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 JAMBOREE RD
Provider Second Line Business Practice Location Address:
SUITE 1200
Provider Business Practice Location Address City Name:
NEWPORT BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92660-2939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
949-988-7888
Provider Business Practice Location Address Fax Number:
949-509-7907
Provider Enumeration Date:
08/04/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BRAY
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT AND CEO
Authorized Official Telephone Number:
310-574-0450

Provider Taxonomy Codes

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

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





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