Organization
RENAISSANCE SURGICAL ARTS AT NEWPORT HARBOR, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRUCE WALLACE (CEO)
(949) 629-1400
Entity
Organization
Contact information
Practice address
1640 NEWPORT BLVD STE 100, COSTA MESA, CA 92627-3786
(949) 629-1400
(949) 629-1500
Mailing address
1640 NEWPORT BLVD STE 100, COSTA MESA, CA 92627-3786
(949) 629-1400
(949) 629-1500
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
07/29/2010
Last updated
09/26/2011
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