Healthcare Provider Details

I. General information

NPI: 1093404139
Provider Name (Legal Business Name): PRECISION SURGICAL INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2023
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 E 7TH ST FL 3
UPLAND CA
91786-6740
US

IV. Provider business mailing address

330 E 7TH ST FL 3
UPLAND CA
91786-6740
US

V. Phone/Fax

Practice location:
  • Phone: 909-352-5560
  • Fax: 909-352-5552
Mailing address:
  • Phone: 909-931-3800
  • Fax: 909-931-3814

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: DIANE CARRASCO
Title or Position: OFFICE MANAGER
Credential:
Phone: 714-850-2060