Healthcare Provider Details

I. General information

NPI: 1578334249
Provider Name (Legal Business Name): MADERA AMBULATORY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2024
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 W YOSEMITE AVE
MADERA CA
93637-4581
US

IV. Provider business mailing address

1015 W YOSEMITE AVE
MADERA CA
93637-4581
US

V. Phone/Fax

Practice location:
  • Phone: 559-907-4002
  • Fax: 559-661-1556
Mailing address:
  • Phone: 559-907-4002
  • Fax: 559-661-1556

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. ARJUN SAMRAN
Title or Position: VICE PRESIDENT / TREASUER
Credential:
Phone: 559-871-2908