Healthcare Provider Details

I. General information

NPI: 1336223585
Provider Name (Legal Business Name): PETER T. TRUONG, M.D., SURGICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9497 N FORT WASHINGTON 103
FRESNO CA
93730-0660
US

IV. Provider business mailing address

9497 N FORT WASHINGTON 103
FRESNO CA
93730-0660
US

V. Phone/Fax

Practice location:
  • Phone: 559-434-9497
  • Fax: 559-434-9499
Mailing address:
  • Phone: 559-434-9497
  • Fax: 559-434-9499

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: PETER T TRUONG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 559-434-9497