Healthcare Provider Details

I. General information

NPI: 1639896384
Provider Name (Legal Business Name): PCCC SURGERY CENTER INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5771 N FRESNO ST STE 101
FRESNO CA
93710-6091
US

IV. Provider business mailing address

3550 Q ST STE 304B
BAKERSFIELD CA
93301-1662
US

V. Phone/Fax

Practice location:
  • Phone: 833-478-1818
  • Fax:
Mailing address:
  • Phone: 833-478-1818
  • Fax: 833-478-1817

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: LORRAINE HERNANDEZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 833-478-1818