Provider Demographics
NPI:1679985857
Name:FOUNTAIN VALLEY SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:FOUNTAIN VALLEY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:TOPP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-427-0880
Mailing Address - Street 1:11190 WARNER AVE.
Mailing Address - Street 2:SUITE 212
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708
Mailing Address - Country:US
Mailing Address - Phone:714-338-1650
Mailing Address - Fax:714-751-2348
Practice Address - Street 1:11190 WARNER AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4019
Practice Address - Country:US
Practice Address - Phone:714-338-1650
Practice Address - Fax:714-751-2348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-22
Last Update Date:2019-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical