Provider Demographics
NPI:1255054375
Name:NOVACARE SURGICAL CENTER A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:NOVACARE SURGICAL CENTER A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANTOINETTE
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:COX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-469-1771
Mailing Address - Street 1:12894 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5807
Mailing Address - Country:US
Mailing Address - Phone:714-537-4400
Mailing Address - Fax:714-537-0400
Practice Address - Street 1:12894 HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-5807
Practice Address - Country:US
Practice Address - Phone:714-537-4400
Practice Address - Fax:714-537-0400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-09-23
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy