Healthcare Provider Details

I. General information

NPI: 1316001738
Provider Name (Legal Business Name): RINALDI SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 TRINITY PKWY SUITE 101
STOCKTON CA
95219-7286
US

IV. Provider business mailing address

10200 TRINITY PKWY SUITE 101
STOCKTON CA
95219-7286
US

V. Phone/Fax

Practice location:
  • Phone: 818-838-0400
  • Fax: 818-838-0420
Mailing address:
  • Phone: 818-838-0400
  • Fax: 818-838-0420

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number09203114275890
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberS051323
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number09203114275890
License Number StateCA

VIII. Authorized Official

Name: DR. LEE JAMES MAREK
Title or Position: OWNER
Credential: DPM
Phone: 831-588-7296