Healthcare Provider Details

I. General information

NPI: 1710842943
Provider Name (Legal Business Name): SACRAMENTO CHILDREN'S SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/19/2025
Last Update Date: 12/19/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12620 VENTURA BLVD STE. 800
ENCINO CA
84088-9274
US

IV. Provider business mailing address

8977 S 1300 W STE 475
WEST JORDAN UT
84088-9274
US

V. Phone/Fax

Practice location:
  • Phone: 818-814-9800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: JEFFERY WHEELER
Title or Position: CEO
Credential:
Phone: 301-494-3000