Provider Demographics
NPI:1568844934
Name:FASHION ISLAND SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:FASHION ISLAND SURGERY CENTER, LLC
Other - Org Name:SURGERY CENTER OF ORANGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-472-4177
Mailing Address - Street 1:302 W LA VETA AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2607
Mailing Address - Country:US
Mailing Address - Phone:661-472-4177
Mailing Address - Fax:760-262-3917
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:661-472-4177
Practice Address - Fax:760-262-3917
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical