Healthcare Provider Details

I. General information

NPI: 1245146554
Provider Name (Legal Business Name): AVICENNA SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PLAZA DR STE 110
FOLSOM CA
95630-4782
US

IV. Provider business mailing address

530 PLAZA DR STE 110
FOLSOM CA
95630-4782
US

V. Phone/Fax

Practice location:
  • Phone: 916-235-6802
  • Fax:
Mailing address:
  • Phone: 916-768-2890
  • 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: MR. PAUL SCHRUPP
Title or Position: CEO
Credential:
Phone: 916-235-6802