Organization
OTAY LAKES SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY KURTH (VP OPERATIONS AND ADMINISTRATION)
(619) 754-2260
Entity
Organization
Contact information
Practice address
955 LANE AVE, SUITE 100, CHULA VISTA, CA 91914-3501
(619) 754-2260
(619) 754-2261
Mailing address
955 LANE AVE, SUITE 100, CHULA VISTA, CA 91914-3501
(619) 754-2260
(619) 754-2261
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SUR01779F
—
CA
Enumeration date
05/17/2006
Last updated
08/22/2020
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