Provider Demographics
NPI:1013962521
Name:NEWPORT PLAZA SURGERY CENTER
Entity Type:Organization
Organization Name:NEWPORT PLAZA SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:MARISALA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-515-1040
Mailing Address - Street 1:1091 NEWPORT BLVD
Mailing Address - Street 2:STE 240
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627
Mailing Address - Country:US
Mailing Address - Phone:949-515-1040
Mailing Address - Fax:858-225-0292
Practice Address - Street 1:1091 NEWPORT BLVD
Practice Address - Street 2:STE 240
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627
Practice Address - Country:US
Practice Address - Phone:949-515-1040
Practice Address - Fax:858-225-0292
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051672Medicare ID - Type UnspecifiedASC