Basic Information
| Provider Information | |||||||||
| NPI: | 1275681579 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOCTORS SURGERY CENTER, A MEDICAL CORPORATION | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | GUARDIAN SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11037 WARNER AVE | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927084007 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7142852385 | ||||||||
| FaxNumber: | 7149627261 | ||||||||
| Practice Location | |||||||||
| Address1: | 10900 WARNER AVE | ||||||||
| Address2: | SUITE 101C | ||||||||
| City: | FOUNTAIN VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927083846 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146981270 | ||||||||
| FaxNumber: | 7149627261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/05/2007 | ||||||||
| LastUpdateDate: | 11/24/2015 | ||||||||
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| AuthorizedOfficialLastName: | BAUMGARTNER | ||||||||
| AuthorizedOfficialFirstName: | FRITZ | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 7142852385 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
ID Information
| ID | Type | State | Issuer | Description | 05D1037474 | 01 | CA | CLIA ID NUMBER | OTHER |