Provider Demographics
NPI:1992846299
Name:LIDO SURGICAL INSTITUTE, LTD.
Entity type:Organization
Organization Name:LIDO SURGICAL INSTITUTE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:BANDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:949-645-9995
Mailing Address - Street 1:320 SUPERIOR AVE STE 180
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-2782
Mailing Address - Country:US
Mailing Address - Phone:949-645-9995
Mailing Address - Fax:
Practice Address - Street 1:320 SUPERIOR AVE STE 180
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-2782
Practice Address - Country:US
Practice Address - Phone:949-645-9995
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZH3073AOtherBLUE SHIELD
CA03 00 N LI ZZZH3073AOtherBLUE SHIELD