Provider Demographics
NPI:1942261599
Name:SDOSC, LP
Entity Type:Organization
Organization Name:SDOSC, LP
Other - Org Name:SAN DIEGO OUTPATIENT AMBULATORY SURGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:V
Authorized Official - Last Name:FOERSTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-299-9530
Mailing Address - Street 1:3939 RUFFIN RD STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1804
Mailing Address - Country:US
Mailing Address - Phone:619-299-9530
Mailing Address - Fax:619-299-3259
Practice Address - Street 1:3939 RUFFIN RD STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1804
Practice Address - Country:US
Practice Address - Phone:619-299-9530
Practice Address - Fax:619-299-3259
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA090000114261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZH3742ZOtherBLUE SHIELD
CAZZT11824GMedicaid
051012OtherBLUE CROSS
ZZZH3742ZOtherBLUE SHIELD