# RENAISSANCE SURGICAL ARTS AT NEWPORT HARBOR, LLC

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

## Provider details

- **NPI number:** 1659685881
- **Authorized official:** MR. BRUCE WALLACE (CEO)
- **Authorized official phone:** (949) 629-1400

## Contact information

- **Practice address:** 1640 NEWPORT BLVD STE 100, COSTA MESA, CA 92627-3786
- **Practice address phone:** (949) 629-1400
- **Practice address fax:** (949) 629-1500
- **Mailing address:** 1640 NEWPORT BLVD STE 100, COSTA MESA, CA 92627-3786
- **Mailing address phone:** (949) 629-1400
- **Mailing address fax:** (949) 629-1500

## Taxonomy

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

## Other

- **Enumeration date:** 07/29/2010
- **Last updated:** 09/26/2011