Healthcare Provider Details

I. General information

NPI: 1740874031
Provider Name (Legal Business Name): DOCTORS OUTPATIENT CENTER FOR SURGERY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2021
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7435 STOCK RANCH ROAD
CITRUS HEIGHTS CA
95621
US

IV. Provider business mailing address

7435 STOCK RANCH ROAD
CITRUS HEIGHTS CA
95621
US

V. Phone/Fax

Practice location:
  • Phone: 972-763-3859
  • Fax:
Mailing address:
  • Phone: 972-763-3859
  • Fax: 972-920-3445

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: ERIC BOON
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269