Organization
MIRAGE AMBULATORY SURGERY CENTER, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHEN L. KREIZENBECK DDS (PRESIDENT)
(760) 779-9989
Entity
Organization
Contact information
Practice address
39935 VISTA DEL SOL, SUITE 102, RANCHO MIRAGE, CA 92270-3211
(760) 779-9989
(760) 779-9710
Mailing address
39935 VISTA DEL SOL, SUITE 102, RANCHO MIRAGE, CA 92270-3211
(760) 779-9989
(760) 779-9710
Taxonomy
Speciality
Code
Description
License number
State
261QS0112X
Oral and Maxillofacial Surgery Clinic/Center
Primary
—
—
Other
Enumeration date
03/04/2010
Last updated
03/04/2010
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