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General NPI Number Information
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NPI Number | 1457643405
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Entity Type | Organization
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Legal Business Name | COFFEE SURGERY CENTER, LLC
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 01/21/2026
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Provider Practice Location Address
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Address Line | 2120 19TH ST
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City | BAKERSFIELD
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State | CA
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Zip | 93301-3709
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Country | US
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Telephone | 661-213-4813
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Fax |
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Provider Business Mailing Address
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Address Line | 9709 LAKESIDE BLVD STE 350
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City | SPRING
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State | TX
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Zip | 77381-1216
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Country | US
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Telephone | 713-489-2198
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Fax | 713-489-2978
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Authorized Official
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Title or Position | CEO
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Name | DEVIN LARSEN
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Credential |
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Telephone | 713-489-2198
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | PENDING
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | PENDING
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License Number State |
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