Provider Demographics
NPI:1558858597
Name:G1 SURGERY CENTER
Entity Type:Organization
Organization Name:G1 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:424-220-4400
Mailing Address - Street 1:1431 WARNER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6444
Mailing Address - Country:US
Mailing Address - Phone:424-220-4400
Mailing Address - Fax:424-220-8344
Practice Address - Street 1:302 W LA VETA AVE STE 100
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2607
Practice Address - Country:US
Practice Address - Phone:424-220-4400
Practice Address - Fax:424-220-8344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-04-16
Last Update Date:2018-08-17
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
CA=========OtherWORKERS COMP-PVT INSURANCE-MEDICARE