Provider Demographics
NPI:1285863696
Name:TEMECULA CA ENDOSCOPY ASC LP
Entity Type:Organization
Organization Name:TEMECULA CA ENDOSCOPY ASC LP
Other - Org Name:TEMECULA VALLEY ENDOSCOPY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF BUSINESS OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-698-8805
Mailing Address - Street 1:25150 HANCOCK AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5987
Mailing Address - Country:US
Mailing Address - Phone:951-698-8805
Mailing Address - Fax:951-698-8898
Practice Address - Street 1:25150 HANCOCK AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5987
Practice Address - Country:US
Practice Address - Phone:951-698-8805
Practice Address - Fax:951-698-8898
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAS308XOtherCRNA - SANDBERG
CACH801ZOtherCRNA-PERRENOUD
CABU941YOtherCRNA - LUCAS
CADB330ZOtherCRNA - FERGUSON
CAAZ149XOtherCRNA - MCNAMARA
CACY651ZOtherCRNA - LYNN
CABB070WOtherCRNA BJERK
CACE284YOtherCRNA - STALLMER
CACH801ZOtherCRNA-PERRENOUD