Provider Demographics
NPI:1619011582
Name:PLAZA SURGICAL CENTER, LP
Entity Type:Organization
Organization Name:PLAZA SURGICAL CENTER, LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:ELAINE
Authorized Official - Last Name:ALEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-450-2225
Mailing Address - Street 1:1105 E SPRUCE AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3313
Mailing Address - Country:US
Mailing Address - Phone:559-450-7300
Mailing Address - Fax:559-450-7336
Practice Address - Street 1:1105 E SPRUCE AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3313
Practice Address - Country:US
Practice Address - Phone:559-450-7300
Practice Address - Fax:559-450-7336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
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
CASUR01674FMedicaid
CAZZZ30406ZMedicare ID - Type UnspecifiedMEDICARE