Provider Demographics
NPI:1023250438
Name:OC MULTISPECIALTY SURGERY CENTER LP
Entity type:Organization
Organization Name:OC MULTISPECIALTY SURGERY CENTER LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:VERBUKH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-827-2549
Mailing Address - Street 1:4333 ADMIRALTY WAY
Mailing Address - Street 2:WEST HELIX 9
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5469
Mailing Address - Country:US
Mailing Address - Phone:310-827-2549
Mailing Address - Fax:424-270-9451
Practice Address - Street 1:14642 NEWPORT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780
Practice Address - Country:US
Practice Address - Phone:714-505-5005
Practice Address - Fax:714-505-5009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-31
Last Update Date:2015-02-24
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
CAF1924Medicare PIN