Provider Demographics
NPI:1508034380
Name:MOSAIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:MOSAIC SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:T
Authorized Official - Last Name:VU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-848-1133
Mailing Address - Street 1:17742 BEACH BLVD
Mailing Address - Street 2:STE. #335
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6818
Mailing Address - Country:US
Mailing Address - Phone:714-848-1133
Mailing Address - Fax:714-848-4114
Practice Address - Street 1:17742 BEACH BLVD
Practice Address - Street 2:STE. #335
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6818
Practice Address - Country:US
Practice Address - Phone:714-848-1133
Practice Address - Fax:714-848-4114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2009-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64785261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA64785BOtherMCARE PROF INDIVID PIN #
CA1043264534OtherPROFESSIONAL CORP NPI #
CA1225081953OtherPROFESSION INDIVID NPI #
CA1225081953OtherPROFESSION INDIVID NPI #
CAWA64785BOtherMCARE PROF INDIVID PIN #