Provider Demographics
NPI:1073094660
Name:CENTRAL VALLEY SURGICAL CENTER LLC
Entity Type:Organization
Organization Name:CENTRAL VALLEY SURGICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:GANESH
Authorized Official - Middle Name:
Authorized Official - Last Name:ACHARYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-370-0721
Mailing Address - Street 1:2120 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3709
Mailing Address - Country:US
Mailing Address - Phone:661-903-9555
Mailing Address - Fax:
Practice Address - Street 1:2120 19TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3709
Practice Address - Country:US
Practice Address - Phone:661-903-9555
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-22
Last Update Date:2020-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1174786347OtherNPI