Healthcare Provider Details

I. General information

NPI: 1922625995
Provider Name (Legal Business Name): NATIONAL SURGICAL CENTERS STOCKTON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2020
Last Update Date: 06/25/2020
Certification Date: 06/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E HARDING WAY STE E
STOCKTON CA
95204-6118
US

IV. Provider business mailing address

561 WINDING BROOK FARM RD
WATERTOWN CT
06795-1747
US

V. Phone/Fax

Practice location:
  • Phone: 310-919-9560
  • Fax:
Mailing address:
  • Phone: 310-919-9560
  • 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: MRS. DIANE L BOONE
Title or Position: CHIEF NURSING OFFICER
Credential: RN
Phone: 312-919-9560