Healthcare Provider Details

I. General information

NPI: 1235106782
Provider Name (Legal Business Name): VALLEY SURGERY CENTER AT MODESTO, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2006
Last Update Date: 11/20/2025
Certification Date: 11/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 MABLE AVE SUITE 1
MODESTO CA
95355-1120
US

IV. Provider business mailing address

1300 MABLE AVE STE 1
MODESTO CA
95355-1120
US

V. Phone/Fax

Practice location:
  • Phone: 209-571-1633
  • Fax: 206-491-0772
Mailing address:
  • Phone: 209-571-1633
  • Fax: 209-491-0772

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: ERIC BOON
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269