Provider Demographics
NPI:1235323361
Name:CENTER FOR ADVANCED LAPAROSCOPIC SURGERY INC
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED LAPAROSCOPIC SURGERY INC
Other - Org Name:CALSURG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:QUEBBEMANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-233-2294
Mailing Address - Street 1:10 TAHOE
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92612-2224
Mailing Address - Country:US
Mailing Address - Phone:949-722-7662
Mailing Address - Fax:
Practice Address - Street 1:12791 NEWPORT AVENUE
Practice Address - Street 2:SUITE 208
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-8023
Practice Address - Country:US
Practice Address - Phone:949-722-7662
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22617Medicare Oscar/Certification