Provider Demographics
NPI:1902042658
Name:CORONA OUTPATIENT SURGICENTER, LLC
Entity Type:Organization
Organization Name:CORONA OUTPATIENT SURGICENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:SCHNEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-737-6363
Mailing Address - Street 1:1124 S MAIN ST
Mailing Address - Street 2:# 101
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-4449
Mailing Address - Country:US
Mailing Address - Phone:951-737-6363
Mailing Address - Fax:951-272-6723
Practice Address - Street 1:1124 S MAIN ST
Practice Address - Street 2:# 101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-4449
Practice Address - Country:US
Practice Address - Phone:951-737-6363
Practice Address - Fax:951-272-6723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-31
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical