Provider Demographics
NPI:1457329963
Name:SEQUOIA SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:SEQUOIA SURGERY CENTER, LLC
Other - Org Name:CYPRESS SURGERY CENTER, A LIMITED PARTNERSHIP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LIDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-740-4094
Mailing Address - Street 1:842 S. AKERS ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-8309
Mailing Address - Country:US
Mailing Address - Phone:559-740-4094
Mailing Address - Fax:559-740-4100
Practice Address - Street 1:842 S. AKERS ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-8309
Practice Address - Country:US
Practice Address - Phone:559-740-4094
Practice Address - Fax:559-740-4094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-09
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA120000610261QA1903X
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUR01313FMedicaid
CAZZZH5401ZMedicare UPIN