Provider Demographics
NPI:1245372531
Name:NEWPORT BAY SURGERY CENTER, LLC
Entity type:Organization
Organization Name:NEWPORT BAY SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:REGINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOORE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:858-735-2192
Mailing Address - Street 1:3333 W COAST HWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4036
Mailing Address - Country:US
Mailing Address - Phone:949-645-6272
Mailing Address - Fax:949-999-0151
Practice Address - Street 1:3333 W COAST HWY
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4036
Practice Address - Country:US
Practice Address - Phone:949-645-6272
Practice Address - Fax:949-999-0151
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2008-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical