Mainbridge Surgery Center Inc.

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

G45605 Issued in CA

Legal business name

MAINBRIDGE SURGERY CENTER INC.

Practice address

400 E Rincon St
Suite 107
Corona, CA 92879-1389

Phone

(714) 771-9252

Fax

(714) 771-8481

NPI assigned

Oct 23, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Larry Wong, MD

Title

Medical Director

Phone

(714) 771-9252

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1382486400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1382486400000",
    "number": "1902234230",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 E RINCON ST",
            "address_2": "SUITE 107",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928791389",
            "telephone_number": "714-771-9252",
            "fax_number": "714-771-8481"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 E RINCON ST",
            "address_2": "SUITE 107",
            "city": "CORONA",
            "state": "CA",
            "postal_code": "928791389",
            "telephone_number": "714-771-9252",
            "fax_number": "714-771-8481"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MAINBRIDGE SURGERY CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-23",
        "last_updated": "2013-10-23",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "LARRY",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "714-771-9252",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "G45605",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Corona, CA
• Providers in Corona, 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 Oct 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.