Provider Demographics
NPI:1497749667
Name:SOUTHERN CALIFORNIA SURGERY CENTER, LP
Entity Type:Organization
Organization Name:SOUTHERN CALIFORNIA SURGERY CENTER, LP
Other - Org Name:CALIFORNIA SPECIALTY SURGERY CENTER, LP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:STAHLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-348-0544
Mailing Address - Street 1:26371 CROWN VALLEY PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6368
Mailing Address - Country:US
Mailing Address - Phone:949-348-0544
Mailing Address - Fax:949-348-1278
Practice Address - Street 1:26371 CROWN VALLEY PKWY
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6368
Practice Address - Country:US
Practice Address - Phone:949-348-0544
Practice Address - Fax:949-348-1278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN CALIFORNIA SURGERY CENTER, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-09-02
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA060000798261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051542Medicare UPIN