# COFFEE ROAD SURGERY CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1134947328
- **Authorized official:** ERIC BOON (OFFICER/AO)
- **Authorized official phone:** (480) 567-0269

## Contact information

- **Practice address:** 1335 COFFEE RD STE 201, MODESTO, CA 95355-3192
- **Practice address phone:** (209) 492-0483
- **Mailing address:** 1335 COFFEE RD STE 201, MODESTO, CA 95355-3192
- **Mailing address phone:** (209) 492-0483

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 09/27/2024
- **Last updated:** 05/08/2026