Provider Demographics
NPI:1619970472
Name:CYPRESS OUTPATIENT SURGICAL CENTER, INC.
Entity Type:Organization
Organization Name:CYPRESS OUTPATIENT SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-476-6943
Mailing Address - Street 1:1665 DOMINICAN WAY
Mailing Address - Street 2:STE 120
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95065-1528
Mailing Address - Country:US
Mailing Address - Phone:831-476-6943
Mailing Address - Fax:
Practice Address - Street 1:1665 DOMINICAN WAY
Practice Address - Street 2:STE 120
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1528
Practice Address - Country:US
Practice Address - Phone:831-476-6943
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA70000225261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ95797ZMedicare ID - Type Unspecified