Provider Demographics
NPI:1124419510
Name:CORONADO SURGERY CENTER LLC
Entity Type:Organization
Organization Name:CORONADO SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-472-4177
Mailing Address - Street 1:4501 BIRCH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-8602
Mailing Address - Country:US
Mailing Address - Phone:661-472-4177
Mailing Address - Fax:760-262-3917
Practice Address - Street 1:4501 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-8602
Practice Address - Country:US
Practice Address - Phone:661-472-4177
Practice Address - Fax:760-262-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-07
Last Update Date:2015-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical