Provider Demographics
NPI:1073794855
Name:SURGICARE OF LA VETA LTD
Entity Type:Organization
Organization Name:SURGICARE OF LA VETA LTD
Other - Org Name:BARRANCA SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-552-6266
Mailing Address - Street 1:3500 BARRANCA PKWY STE 130
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-8227
Mailing Address - Country:US
Mailing Address - Phone:949-552-6266
Mailing Address - Fax:949-552-5038
Practice Address - Street 1:3500 BARRANCA PKWY SUITE 130
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92606-8227
Practice Address - Country:US
Practice Address - Phone:949-552-6266
Practice Address - Fax:949-552-5038
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-20
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical