Provider Demographics
NPI:1407869373
Name:VALENCIA ASC, LLC
Entity Type:Organization
Organization Name:VALENCIA ASC, LLC
Other - Org Name:VALENCIA SUGICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER AND AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:BALDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-234-5954
Mailing Address - Street 1:24355 LYONS AVE
Mailing Address - Street 2:120
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91321-2300
Mailing Address - Country:US
Mailing Address - Phone:661-255-6644
Mailing Address - Fax:661-255-7653
Practice Address - Street 1:24355 LYONS AVE
Practice Address - Street 2:120
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-2300
Practice Address - Country:US
Practice Address - Phone:661-255-6644
Practice Address - Fax:661-255-7653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-14
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA930000463261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051206AMedicare ID - Type Unspecified