Healthcare Provider Details

I. General information

NPI: 1407619778
Provider Name (Legal Business Name): POINT WEST SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1525 RESPONSE RD
SACRAMENTO CA
95815-4801
US

IV. Provider business mailing address

2805 J ST STE 100
SACRAMENTO CA
95816-4307
US

V. Phone/Fax

Practice location:
  • Phone: 916-492-1828
  • Fax:
Mailing address:
  • Phone: 916-492-1828
  • Fax: 916-492-1834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J FAZIO
Title or Position: DIRECTOR
Credential: MD
Phone: 916-492-1828