Provider Demographics
NPI:1003997503
Name:FOUR SEASONS SURGERY CENTERS OF ANAHEIM LP
Entity Type:Organization
Organization Name:FOUR SEASONS SURGERY CENTERS OF ANAHEIM LP
Other - Org Name:FOUR SEASONS SURGERY CENTERS OF ANAHEIM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CONTRACTING
Authorized Official - Prefix:MR
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-371-7105
Mailing Address - Street 1:1324 S EUCLID ST
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92802-2002
Mailing Address - Country:US
Mailing Address - Phone:714-262-0047
Mailing Address - Fax:714-262-0060
Practice Address - Street 1:1324 S EUCLID ST
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92802-2002
Practice Address - Country:US
Practice Address - Phone:714-262-0047
Practice Address - Fax:714-262-0060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000785261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical