Basic Information
| Provider Information | |||||||||
| NPI: | 1669660817 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPH IRVINE, L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20360 SW BIRCH ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926601532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498331432 | ||||||||
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| Practice Location | |||||||||
| Address1: | 20360 SW BIRCH ST STE 110 | ||||||||
| Address2: | |||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926601532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9498331432 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/11/2007 | ||||||||
| LastUpdateDate: | 09/21/2018 | ||||||||
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| AuthorizedOfficialLastName: | FRIEDLANDER | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF EXECUTIVE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9497055105 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 060000281 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.