Provider Demographics
NPI:1114707601
Name:GENESIS AMBULATORY SURGERY CENTER, INC.
Entity Type:Organization
Organization Name:GENESIS AMBULATORY SURGERY CENTER, INC.
Other - Org Name:GENESIS AMBULATORY SURGERY CENTER, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:YASSER
Authorized Official - Middle Name:HILMY
Authorized Official - Last Name:SALEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-545-5200
Mailing Address - Street 1:PO BOX 2393
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92859-0393
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1401 N TUSTIN AVE STE 160
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8652
Practice Address - Country:US
Practice Address - Phone:949-837-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENESIS SURGERY CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-10-02
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical