Healthcare Provider Details

I. General information

NPI: 1922546019
Provider Name (Legal Business Name): SILLECT CENTER FOR SURGERY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2017
Last Update Date: 02/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3545 SAN DIMAS ST
BAKERSFIELD CA
93301-1605
US

IV. Provider business mailing address

2901 SILLECT AVE STE 201
BAKERSFIELD CA
93308-6373
US

V. Phone/Fax

Practice location:
  • Phone: 661-327-2101
  • Fax: 661-327-2554
Mailing address:
  • Phone: 661-327-2101
  • Fax: 661-327-2101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA063639
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberA063639
License Number StateCA

VIII. Authorized Official

Name: DR. VIPUL R DEV
Title or Position: OWNER
Credential: M.D.
Phone: 661-327-2101