Provider Demographics
NPI:1922128792
Name:LA REGIONAL SURGICAL CENTER
Entity Type:Organization
Organization Name:LA REGIONAL SURGICAL CENTER
Other - Org Name:OC REGIONAL SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:VERBUKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-301-8329
Mailing Address - Street 1:302 W LA VETA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92866-2607
Mailing Address - Country:US
Mailing Address - Phone:714-516-2605
Mailing Address - Fax:
Practice Address - Street 1:302 W LA VETA AVE
Practice Address - Street 2:STE. 100
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2607
Practice Address - Country:US
Practice Address - Phone:714-516-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACX789AMedicare PIN