Provider Demographics
NPI:1346427689
Name:CORONADO SURGERY CENTER
Entity Type:Organization
Organization Name:CORONADO SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CROVETTI
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:702-932-8368
Mailing Address - Street 1:880 SEVEN HILLS DR STE 140
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89052-4380
Mailing Address - Country:US
Mailing Address - Phone:702-932-8368
Mailing Address - Fax:702-932-8377
Practice Address - Street 1:880 SEVEN HILLS DR STE 140
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-4380
Practice Address - Country:US
Practice Address - Phone:702-932-8368
Practice Address - Fax:702-932-8377
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2008-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical