Basic Information
| Provider Information | |||||||||
| NPI: | 1407869373 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | VALENCIA ASC, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | VALENCIA SUGICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 24355 LYONS AVE | ||||||||
| Address2: | 120 | ||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913212300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612556644 | ||||||||
| FaxNumber: | 6612557653 | ||||||||
| Practice Location | |||||||||
| Address1: | 24355 LYONS AVE | ||||||||
| Address2: | 120 | ||||||||
| City: | SANTA CLARITA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 913212300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6612556644 | ||||||||
| FaxNumber: | 6612557653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/14/2006 | ||||||||
| LastUpdateDate: | 08/20/2019 | ||||||||
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| AuthorizedOfficialLastName: | BALDOCK | ||||||||
| AuthorizedOfficialFirstName: | JENNIFER | ||||||||
| AuthorizedOfficialMiddleName: | BOYD | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICER AND AUTHORIZED OFFICIAL | ||||||||
| AuthorizedOfficialTelephone: | 6152345935 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | 930000463 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.