Provider Demographics
NPI:1952813008
Name:PACIFIC SURGICAL LLC.
Entity Type:Organization
Organization Name:PACIFIC SURGICAL LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:KARA
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-566-5240
Mailing Address - Street 1:17672 BEACH BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-6836
Mailing Address - Country:US
Mailing Address - Phone:714-566-5240
Mailing Address - Fax:888-977-3286
Practice Address - Street 1:17672 BEACH BLVD STE B
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-6836
Practice Address - Country:US
Practice Address - Phone:714-566-5240
Practice Address - Fax:888-977-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical