Provider Demographics
NPI:1689763617
Name:CENTER FOR SURGERY OF NORTH COAST L.P.
Entity Type:Organization
Organization Name:CENTER FOR SURGERY OF NORTH COAST L.P.
Other - Org Name:CENTER FOR SURGERY OF ENCINITAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:760-942-6325
Mailing Address - Street 1:477 N EL CAMINO REAL STE C100
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1332
Mailing Address - Country:US
Mailing Address - Phone:760-942-8800
Mailing Address - Fax:760-942-5238
Practice Address - Street 1:477 N EL CAMINO REAL STE C100
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1332
Practice Address - Country:US
Practice Address - Phone:760-942-8800
Practice Address - Fax:760-942-5238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2016-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA080000373261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051029Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID#