Provider Demographics
NPI:1306851902
Name:SPECIALTY SURGICAL CENTER OF IRVINE LP
Entity type:Organization
Organization Name:SPECIALTY SURGICAL CENTER OF IRVINE LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:B
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:15825 LAGUNA CANYON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2127
Mailing Address - Country:US
Mailing Address - Phone:949-341-3499
Mailing Address - Fax:949-788-0556
Practice Address - Street 1:15825 LAGUNA CANYON RD
Practice Address - Street 2:STE. 200
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2125
Practice Address - Country:US
Practice Address - Phone:310-659-6333
Practice Address - Fax:310-659-2333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051671Medicare ID - Type UnspecifiedSO. CAL PART B