Healthcare Provider Details

I. General information

NPI: 1407116361
Provider Name (Legal Business Name): MONTEREY PENINSULA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2265 41ST AVENUE
CAPITOLA CA
95010
US

IV. Provider business mailing address

9699 BLUE LARKSPUR LN STE 202
MONTEREY CA
93940-6552
US

V. Phone/Fax

Practice location:
  • Phone: 831-372-2169
  • Fax: 831-372-6323
Mailing address:
  • Phone: 831-372-2169
  • Fax: 831-372-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CARRIE MILLSAP
Title or Position: CEO
Credential: BSN
Phone: 831-372-2169