Provider Demographics
NPI:1780688499
Name:THE CENTER FOR ENDOSCOPY
Entity Type:Organization
Organization Name:THE CENTER FOR ENDOSCOPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:L
Authorized Official - Last Name:BLANKENHORN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-940-6300
Mailing Address - Street 1:3921 WARING RD
Mailing Address - Street 2:STE B
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4456
Mailing Address - Country:US
Mailing Address - Phone:760-940-6300
Mailing Address - Fax:760-940-8074
Practice Address - Street 1:3921 WARING RD
Practice Address - Street 2:STE B
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4456
Practice Address - Country:US
Practice Address - Phone:760-940-6300
Practice Address - Fax:760-940-8074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2020-08-22
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
CAS051204Medicare ID - Type UnspecifiedMEDICARE IDENTIFICATION