Basic Information
| Provider Information | |||||||||
| NPI: | 1962695122 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTH ORANGE COUNTY SURGERY CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1741 W ROMNEYA DR | ||||||||
| Address2: | SUITE F | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928011805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144089481 | ||||||||
| FaxNumber: | 7142840164 | ||||||||
| Practice Location | |||||||||
| Address1: | 1741 W ROMNEYA DR | ||||||||
| Address2: | SUITE F | ||||||||
| City: | ANAHEIM | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928011805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7144089481 | ||||||||
| FaxNumber: | 7142840164 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2007 | ||||||||
| LastUpdateDate: | 09/25/2014 | ||||||||
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| AuthorizedOfficialLastName: | GADDAM | ||||||||
| AuthorizedOfficialFirstName: | SYAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 17146369100 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | PENDING | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.