Healthcare Provider Details

I. General information

NPI: 1811292063
Provider Name (Legal Business Name): FIRST INTERVENTIONAL SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 01/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 N 1ST ST
FRESNO CA
93710-5446
US

IV. Provider business mailing address

PO BOX 3969
CERRITOS CA
90703-3969
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-6211
  • Fax: 559-431-6202
Mailing address:
  • Phone: 562-407-2080
  • Fax: 562-407-2082

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: JOHN F PETRAGLIA
Title or Position: OWNER
Credential: M.D.
Phone: 559-431-6211