Healthcare Provider Details

I. General information

NPI: 1104850312
Provider Name (Legal Business Name): MONTEREY PENINSULA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/30/2025
Certification Date: 12/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

966 CASS ST STE 150
MONTEREY CA
93940-4522
US

IV. Provider business mailing address

966 CASS ST STE 150
MONTEREY CA
93940-4522
US

V. Phone/Fax

Practice location:
  • Phone: 831-372-2169
  • Fax: 831-372-6323
Mailing address:
  • Phone: 831-372-2169
  • Fax: 831-372-6323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number070000398
License Number StateCA

VIII. Authorized Official

Name: MS. CARRIE MILLSAP
Title or Position: CEO
Credential:
Phone: 831-372-2169