Organization
AMBULATORY CARE SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CAROLINE BADDOUR (CEO)
(858) 974-7200
Entity
Organization
Contact information
Practice address
5225 KEARNY VILLA WAY, SAN DIEGO, CA 92123-1410
(858) 974-7200
(858) 974-7245
Mailing address
5225 KEARNY VILLA WAY, SAN DIEGO, CA 92123-1410
(858) 974-7200
(858) 974-7245
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
080000458
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080000458
STATE OF CALIFORNIA LICEN
CA
Enumeration date
06/04/2006
Last updated
10/18/2010
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