Healthcare Provider Details

I. General information

NPI: 1114266970
Provider Name (Legal Business Name): SUN VALLEY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2013
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4090 N MLK BLVD
NORTH LAS VEGAS NV
89032
US

IV. Provider business mailing address

4090 N MLK BLVD
NORTH LAS VEGAS NV
89032-3218
US

V. Phone/Fax

Practice location:
  • Phone: 425-306-2579
  • Fax:
Mailing address:
  • Phone:
  • 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: CHRISTIAN GARAYCOCHEA
Title or Position: OWNER, MEDICAL DIRECTOR
Credential: M.D.
Phone: 801-368-0468