Provider Demographics
NPI:1881170108
Name:NEWPORT COAST SURGICAL CENTER, LLC
Entity type:Organization
Organization Name:NEWPORT COAST SURGICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELENA
Authorized Official - Middle Name:
Authorized Official - Last Name:SERDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-472-4177
Mailing Address - Street 1:2711 N SEPULVEDA BLVD # 223
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2725
Mailing Address - Country:US
Mailing Address - Phone:661-472-4177
Mailing Address - Fax:
Practice Address - Street 1:4501 BIRCH ST STE A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1928
Practice Address - Country:US
Practice Address - Phone:661-472-4177
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-19
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty