Healthcare Provider Details

I. General information

NPI: 1497120463
Provider Name (Legal Business Name): THE CARDIOVASCULAR SURGICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2015
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 SONOMA ST STE B
REDDING CA
96001-3026
US

IV. Provider business mailing address

2425 SONOMA ST
REDDING CA
96001-3026
US

V. Phone/Fax

Practice location:
  • Phone: 530-241-1144
  • Fax: 530-241-1142
Mailing address:
  • Phone: 530-241-1144
  • Fax: 530-241-1142

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA49275
License Number StateCA

VIII. Authorized Official

Name: MISS SABINA DUGGAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 530-241-1144