Healthcare Provider Details

I. General information

NPI: 1073758264
Provider Name (Legal Business Name): TRINITY PLAZA SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 12/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10200 TRINITY PKWY SUITE 101
STOCKTON CA
95219-7249
US

IV. Provider business mailing address

10200 TRINITY PKWY SUITE 101
STOCKTON CA
95219-7249
US

V. Phone/Fax

Practice location:
  • Phone: 209-323-3480
  • Fax:
Mailing address:
  • Phone: 209-323-3480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. JOSEPH HARRINGTON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 209-334-3411