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General NPI Number Information
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NPI Number | 1942245725
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Entity Type | Organization
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Legal Business Name | SIERRA PACIFIC SURGERY CENTER LLC
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Dates
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Enumeration Date | 06/17/2006
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Last Update Date | 01/14/2025
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Provider Practice Location Address
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Address Line | 1630 E HERNDON AVE SUITE 100
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City | FRESNO
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State | CA
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Zip | 93720-3305
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Country | US
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Telephone | 559-449-2888
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 E HERNDON AVE STE 100
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City | FRESNO
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State | CA
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Zip | 93720-3391
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Country | US
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Telephone | 559-449-2888
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Fax | 559-256-9944
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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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 | CA
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