Provider Demographics
NPI:1790497204
Name:RIVERWALK SURGICAL CENTER, INC.
Entity Type:Organization
Organization Name:RIVERWALK SURGICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIAL
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-910-6890
Mailing Address - Street 1:9610 STOCKDALE HWY UNIT A
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-3626
Mailing Address - Country:US
Mailing Address - Phone:661-664-0314
Mailing Address - Fax:
Practice Address - Street 1:9610 STOCKDALE HWY UNIT A
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3626
Practice Address - Country:US
Practice Address - Phone:661-664-0314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-15
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2300174704OtherCITY BUSINESS LICENSE
CA36987OtherANTHEM BLUE CROSS