Provider Demographics
NPI:1578675062
Name:COBO SURGICAL MEDICAL ASSOCIATES,INC
Entity Type:Organization
Organization Name:COBO SURGICAL MEDICAL ASSOCIATES,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUAN CARLOS
Authorized Official - Middle Name:
Authorized Official - Last Name:COBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-364-5096
Mailing Address - Street 1:24310 MOULTON PKWY
Mailing Address - Street 2:STE O-#563
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92637-3306
Mailing Address - Country:US
Mailing Address - Phone:949-297-3612
Mailing Address - Fax:949-495-8258
Practice Address - Street 1:24310 MOULTON PKWY
Practice Address - Street 2:STE O-#563
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92637-3306
Practice Address - Country:US
Practice Address - Phone:949-297-3612
Practice Address - Fax:949-495-8258
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2014-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42070208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16111Medicare PIN