Otay Lakes Surgery Center, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

OTAY LAKES SURGERY CENTER, LLC

Practice address

955 Lane Ave
Suite 100
Chula Vista, CA 91914-3501

Phone

(619) 754-2260

Fax

(619) 754-2261

NPI assigned

May 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Gary Kurth

Title

VP Operations and Administration

Phone

(619) 754-2260

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Listed as

Otay Lakes Surgery Center LLCCCN 05C0001779

Medicare certification status

ActiveFrom the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 3

Organizations this organization is a member of, according to the National Provider Directory.

• Kenneth a. Romero, M.D., Inc

  • Pain Medicine Physician
  • Chula Vista, CA
  • NPI 1679604714

  Member Of

  NPD member
• La Jolla Spine Institute Medical Group, Inc.

  • Orthopaedic Surgery of the Spine Physician
  • San Diego, CA
  • NPI 1073677811

  Member Of

  NPD member
• Synergy Orthopedic Specialists, Inc.

  • Specialist
  • La Jolla, CA
  • NPI 1790445229

  Member Of

  NPD member

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Anthony G Sanzone, M.D.

  • Orthopaedic Surgery Physician
  • Chula Vista, CA
  • NPI 1992747059
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147824000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1376595421",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "955 LANE AVE",
            "address_2": "SUITE 100",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919143501",
            "telephone_number": "619-754-2260",
            "fax_number": "619-754-2261"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 LANE AVE",
            "address_2": "SUITE 100",
            "city": "CHULA VISTA",
            "state": "CA",
            "postal_code": "919143501",
            "telephone_number": "619-754-2260",
            "fax_number": "619-754-2261"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OTAY LAKES SURGERY CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KURTH",
        "authorized_official_first_name": "GARY",
        "authorized_official_title_or_position": "VP OPERATIONS AND ADMINISTRATION",
        "authorized_official_telephone_number": "619-754-2260",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SUR01779F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cordelia Fanny Ossavou
• Tiffany G Osterbur
• Brooke Olivia Ostrom
• Erika Osuna
• Vivian Osunde, RN
• Cathy Otero
• Jessica Ouderkirk
• Karen Ovadia
• Ciarra Renea Ovalle
• Jeffrey Scott Overcash, MD

• Ambulatory Surgical Clinic/Center in Chula Vista, CA
• Providers in Chula Vista, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.