Provider Demographics
NPI:1205077724
Name:CORONA SURGERY CENTER, LLC
Entity type:Organization
Organization Name:CORONA SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLACHARSKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-738-8383
Mailing Address - Street 1:1810 FULLERTON AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-3103
Mailing Address - Country:US
Mailing Address - Phone:951-738-8383
Mailing Address - Fax:951-738-8788
Practice Address - Street 1:1810 FULLERTON AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-3103
Practice Address - Country:US
Practice Address - Phone:951-738-8383
Practice Address - Fax:951-738-8788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INLAND VALLEY RETINA MEDICAL ASSOCIATES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-03-12
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44451207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty