# OTAY LAKES SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1376595421
- **Authorized official:** MR. GARY KURTH (VP OPERATIONS AND ADMINISTRATION)
- **Authorized official phone:** (619) 754-2260

## Contact information

- **Practice address:** 955 LANE AVE, SUITE 100, CHULA VISTA, CA 91914-3501
- **Practice address phone:** (619) 754-2260
- **Practice address fax:** (619) 754-2261
- **Mailing address:** 955 LANE AVE, SUITE 100, CHULA VISTA, CA 91914-3501
- **Mailing address phone:** (619) 754-2260
- **Mailing address fax:** (619) 754-2261

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 05/17/2006
- **Last updated:** 08/22/2020