Organization
HALCYON LASER & SURGERY CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SANJA BREWER (DIRECTOR OF OPERATIONS)
(805) 541-1342
Entity
Organization
Contact information
Practice address
303 S HALCYON RD, ARROYO GRANDE, CA 93420-3817
(805) 489-8254
(805) 474-1997
Mailing address
303 S HALCYON RD, ARROYO GRANDE, CA 93420-3817
(805) 489-8254
(805) 474-1997
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
051344
BLUE CROSS OF CALIFORNIA
CA
05
—
SUR01344F
—
CA
01
—
ZZZH4003Z
BLUE SHIELD OF CA
CA
Enumeration date
04/19/2006
Last updated
07/16/2007
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