Provider Demographics
NPI:1497046064
Name:PACIFIC SHORE SURGERY CENTER
Entity Type:Organization
Organization Name:PACIFIC SHORE SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:BERNARD
Authorized Official - Last Name:GIACOBETTI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-285-0014
Mailing Address - Street 1:902 N GRAND AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92701-4218
Mailing Address - Country:US
Mailing Address - Phone:714-285-0014
Mailing Address - Fax:714-285-0018
Practice Address - Street 1:302 W. LAVETA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866
Practice Address - Country:US
Practice Address - Phone:714-516-2605
Practice Address - Fax:714-285-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA425960261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical