Provider Demographics
NPI:1962673434
Name:DAVID M. CRNIC, MD
Entity Type:Organization
Organization Name:DAVID M. CRNIC, MD
Other - Org Name:SOUTH COUNTY SURGICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CRNIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-645-2288
Mailing Address - Street 1:307 PLACENTIA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-3307
Mailing Address - Country:US
Mailing Address - Phone:949-645-2288
Mailing Address - Fax:949-574-8161
Practice Address - Street 1:307 PLACENTIA AVE STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3307
Practice Address - Country:US
Practice Address - Phone:949-645-2288
Practice Address - Fax:949-574-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-12
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46173208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA50312Medicare UPIN