Provider Demographics
NPI:1104698638
Name:OC SURGICAL SUPPORT LLC
Entity type:Organization
Organization Name:OC SURGICAL SUPPORT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:CARRY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:310-543-7779
Mailing Address - Street 1:1231 CABRILLO AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-2867
Mailing Address - Country:US
Mailing Address - Phone:310-543-7779
Mailing Address - Fax:844-386-5090
Practice Address - Street 1:4501 BIRCH ST STE 101A
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1990
Practice Address - Country:US
Practice Address - Phone:310-543-7779
Practice Address - Fax:844-386-5090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-27
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty