Basic Information
| Provider Information | |||||||||
| NPI: | 1619970472 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CYPRESS OUTPATIENT SURGICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1665 DOMINICAN WAY | ||||||||
| Address2: | STE 120 | ||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950651528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314766943 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1665 DOMINICAN WAY | ||||||||
| Address2: | STE 120 | ||||||||
| City: | SANTA CRUZ | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950651528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8314766943 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2005 | ||||||||
| LastUpdateDate: | 09/15/2022 | ||||||||
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| AuthorizedOfficialLastName: | OWENS | ||||||||
| AuthorizedOfficialFirstName: | LOIS | ||||||||
| AuthorizedOfficialMiddleName: | ELAINE | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8314766943 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 70000225 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.