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General NPI Number Information
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NPI Number | 1114266970
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Entity Type | Organization
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Legal Business Name | SUN VALLEY SURGERY CENTER, LLC
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Dates
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Enumeration Date | 02/13/2013
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Last Update Date | 06/05/2018
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Provider Practice Location Address
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Address Line | 4090 N MLK BLVD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032
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Country | US
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Telephone | 425-306-2579
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Fax |
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Provider Business Mailing Address
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Address Line | 4090 N MLK BLVD
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City | NORTH LAS VEGAS
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State | NV
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Zip | 89032-3218
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, MEDICAL DIRECTOR
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Name | CHRISTIAN GARAYCOCHEA
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Credential | M.D.
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Telephone | 801-368-0468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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