Healthcare Provider Details

I. General information

NPI: 1831952779
Provider Name (Legal Business Name): MC SURGICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2024
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4459 HILLTOP RD
SOQUEL CA
95073-2310
US

IV. Provider business mailing address

4459 HILLTOP RD
SOQUEL CA
95073-2310
US

V. Phone/Fax

Practice location:
  • Phone: 831-818-4721
  • Fax:
Mailing address:
  • Phone: 831-818-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MELISSA JOY CLAY
Title or Position: CEO
Credential: NP
Phone: 831-818-4721