Provider Demographics
NPI:1356413678
Name:OCEANVIEW AMBULATORY SURGERY CENTER LLC
Entity type:Organization
Organization Name:OCEANVIEW AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:C
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-499-2800
Mailing Address - Street 1:31852 PACIFIC COAST HIGHWAY
Mailing Address - Street 2:SUITE 403
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651
Mailing Address - Country:US
Mailing Address - Phone:949-499-2800
Mailing Address - Fax:949-499-9590
Practice Address - Street 1:31852 PACIFIC COAST HIGHWAY
Practice Address - Street 2:SUITE 403
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651
Practice Address - Country:US
Practice Address - Phone:949-499-2800
Practice Address - Fax:949-499-9590
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
S051283Medicare PIN
CA=========OtherTAX ID