Basic Information
| Provider Information | |||||||||
| NPI: | 1104985910 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOOTHILL SURGICAL INSTITUTE, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 27758 SANTA MARGARITA PKWY | ||||||||
| Address2: | #364 | ||||||||
| City: | MISSION VIEJO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926916709 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497159112 | ||||||||
| FaxNumber: | 9497675764 | ||||||||
| Practice Location | |||||||||
| Address1: | 29300 PORTOLA PKWY | ||||||||
| Address2: | SUITE A | ||||||||
| City: | LAKE FOREST | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926308718 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9497159112 | ||||||||
| FaxNumber: | 9497675764 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2006 | ||||||||
| LastUpdateDate: | 07/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | PADILLA | ||||||||
| AuthorizedOfficialFirstName: | PATTI | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9497159112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.