Provider Demographics
NPI:1407969561
Name:SADDLEBACK OUTPATIENT SURGERY CENTER LTD
Entity Type:Organization
Organization Name:SADDLEBACK OUTPATIENT SURGERY CENTER LTD
Other - Org Name:SADDLEBACK VALLEY OUTPATIENT SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:FITZGERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-472-4887
Mailing Address - Street 1:24302 PASEO DE VALENCIA
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3115
Mailing Address - Country:US
Mailing Address - Phone:949-472-0244
Mailing Address - Fax:
Practice Address - Street 1:24302 PASEO DE VALENCIA
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3115
Practice Address - Country:US
Practice Address - Phone:949-472-0244
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS551042Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER
CAY551042Medicare ID - Type UnspecifiedID# FOR IOL'S, SUPPLIES