Provider Demographics
NPI:1548403744
Name:STOCKDALE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:STOCKDALE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-665-7885
Mailing Address - Street 1:9802 STOCKDALE HWY
Mailing Address - Street 2:104
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3613
Mailing Address - Country:US
Mailing Address - Phone:661-665-7885
Mailing Address - Fax:661-735-3941
Practice Address - Street 1:9802 STOCKDALE HWY
Practice Address - Street 2:104
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3613
Practice Address - Country:US
Practice Address - Phone:661-665-7885
Practice Address - Fax:661-735-3941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-17
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF1940OtherPTAN