Healthcare Provider Details

I. General information

NPI: 1548085673
Provider Name (Legal Business Name): SACRAMENTO PREMIER SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/22/2024
Last Update Date: 11/22/2024
Certification Date: 11/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 PLAZA DR STE 110
FOLSOM CA
95630-4782
US

IV. Provider business mailing address

425 15TH ST UNIT 3195
MANHATTAN BEACH CA
90266-7316
US

V. Phone/Fax

Practice location:
  • Phone: 818-855-1507
  • Fax:
Mailing address:
  • Phone: 818-855-1507
  • 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: PELIN SEN
Title or Position: CHIEF OPERATING OFFICER
Credential: MBA
Phone: 818-855-1507