Provider Demographics
NPI:1083886394
Name:CALIFORNIA SURGICAL INSTITUTE
Entity Type:Organization
Organization Name:CALIFORNIA SURGICAL INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SITE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAVIER
Authorized Official - Middle Name:
Authorized Official - Last Name:ERIVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:866-372-3288
Mailing Address - Street 1:910 E BIRCH ST
Mailing Address - Street 2:SUITE 350
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-5800
Mailing Address - Country:US
Mailing Address - Phone:714-990-9012
Mailing Address - Fax:714-990-9015
Practice Address - Street 1:910 E BIRCH ST
Practice Address - Street 2:SUITE 350
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5800
Practice Address - Country:US
Practice Address - Phone:714-990-9012
Practice Address - Fax:714-990-9015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75774261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA75774OtherUPIN