Provider Demographics
NPI:1841259694
Name:ENT FACIAL SURGERY CENTER LLC
Entity type:Organization
Organization Name:ENT FACIAL SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAINAUSKAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:559-432-3724
Mailing Address - Street 1:1351 E SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3342
Mailing Address - Country:US
Mailing Address - Phone:559-432-3303
Mailing Address - Fax:559-432-1468
Practice Address - Street 1:1351 E SPRUCE AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3342
Practice Address - Country:US
Practice Address - Phone:559-432-3303
Practice Address - Fax:559-432-1468
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-21
Last Update Date:2018-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASURG01199FMedicaid
CAZZZH1013ZMedicare ID - Type Unspecified