Provider Demographics
NPI:1831371749
Name:PRISTINE SURGERY CENTER, INC
Entity type:Organization
Organization Name:PRISTINE SURGERY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PINKY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-431-8888
Mailing Address - Street 1:7685 N KAVANAGH AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-0362
Mailing Address - Country:US
Mailing Address - Phone:559-431-8888
Mailing Address - Fax:559-447-8400
Practice Address - Street 1:7085 N MAPLE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-8011
Practice Address - Country:US
Practice Address - Phone:559-431-8888
Practice Address - Fax:559-447-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical