Provider Demographics
NPI:1013733641
Name:SOCAL ONCOPLASTIC SURGERY PC
Entity type:Organization
Organization Name:SOCAL ONCOPLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-229-7971
Mailing Address - Street 1:2661 VISTA ORNADA
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3555
Mailing Address - Country:US
Mailing Address - Phone:949-229-7971
Mailing Address - Fax:949-539-0897
Practice Address - Street 1:601 DOVER DR STE 2
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-5700
Practice Address - Country:US
Practice Address - Phone:949-229-7971
Practice Address - Fax:949-539-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-27
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty