Healthcare Provider Details

I. General information

NPI: 1013633163
Provider Name (Legal Business Name): VALLEY SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 10/19/2022
Certification Date: 03/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 W YOSEMITE AVE STE 2
MANTECA CA
95337-5192
US

IV. Provider business mailing address

1335 STANFORD AVE
EMERYVILLE CA
94608-2536
US

V. Phone/Fax

Practice location:
  • Phone: 510-647-5101
  • Fax: 510-647-5105
Mailing address:
  • Phone: 510-647-5101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NINA KINTANAR
Title or Position: CHIEF ADMINISTRATIVE OFFICER
Credential:
Phone: 510-647-5101