Provider Demographics
NPI:1356395354
Name:NEWPORT COAST OUTPATIENT SURGERY CENTER
Entity type:Organization
Organization Name:NEWPORT COAST OUTPATIENT SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:M
Authorized Official - Last Name:GRAZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-644-1240
Mailing Address - Street 1:400 NEWPORT CENTER DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7601
Mailing Address - Country:US
Mailing Address - Phone:949-644-1240
Mailing Address - Fax:949-644-9274
Practice Address - Street 1:400 NEWPORT CENTER DR
Practice Address - Street 2:SUITE 300
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7601
Practice Address - Country:US
Practice Address - Phone:949-644-1240
Practice Address - Fax:949-644-9274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical