Basic Information
| Provider Information | |||||||||
| NPI: | 1487920716 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL VALLEY SURGERY CENTER INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2725 16TH ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933013355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055633307 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2725 16TH ST | ||||||||
| Address2: | |||||||||
| City: | BAKERSFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 933013355 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8055633307 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2012 | ||||||||
| LastUpdateDate: | 03/07/2014 | ||||||||
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| AuthorizedOfficialLastName: | MOELLEKEN | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8055633307 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.