Basic Information
| Provider Information | |||||||||
| NPI: | 1023421146 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PRIME SURGICAL CTR OF FOOTHILL RANCH, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 N BRAND BLVD STE 900 | ||||||||
| Address2: | |||||||||
| City: | GLENDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 912034721 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189379969 | ||||||||
| FaxNumber: | 8189379968 | ||||||||
| Practice Location | |||||||||
| Address1: | 27462 PORTOLA PKWY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FOOTHILL RANCH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926102838 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9499001340 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2014 | ||||||||
| LastUpdateDate: | 10/11/2022 | ||||||||
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| AuthorizedOfficialLastName: | SINGER | ||||||||
| AuthorizedOfficialFirstName: | CAROLINE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 8189379969 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | PRIME SURGICAL AFFILIATES | ||||||||
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| AuthorizedOfficialCredential: | CASC | ||||||||
| NPICertificationDate: | 10/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.