Provider Demographics
NPI:1578593281
Name:SOUTH ORANGE COUNTY OUTPATIENT SURGICAL CENTER INC
Entity Type:Organization
Organization Name:SOUTH ORANGE COUNTY OUTPATIENT SURGICAL CENTER INC
Other - Org Name:SOUTH ORANGE COUNTY OUTPATIENT SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:V
Authorized Official - Last Name:OHANESIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-951-2020
Mailing Address - Street 1:24401 CALLE DE LA LOUISA
Mailing Address - Street 2:SUITE 300
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3623
Mailing Address - Country:US
Mailing Address - Phone:949-951-2020
Mailing Address - Fax:949-900-5321
Practice Address - Street 1:665 CAMINO DE LOS MARES
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-2859
Practice Address - Country:US
Practice Address - Phone:949-951-2020
Practice Address - Fax:949-900-5321
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-06-25
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
CAS551070Medicare ID - Type Unspecified