# MICHAEL J FAZIO, MD, SURGERY CENTER

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

## Provider details

- **NPI number:** 1295739134
- **Authorized official:** ANNETTE BUKOWIEC (MEDICAL BILLING REPRESENTATIVE)
- **Authorized official phone:** (916) 492-1828

## Contact information

- **Practice address:** 2805 J ST, STE 100, SACRAMENTO, CA 95816-4307
- **Practice address phone:** (916) 492-1828
- **Practice address fax:** (916) 492-1834
- **Mailing address:** FILE \# 74529, PO BOX 60000, SAN FRANCISCO, CA 94160
- **Mailing address phone:** (916) 492-1828
- **Mailing address fax:** (916) 492-1834

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | CLN 670 | CA | Yes |

## Other

- **Enumeration date:** 06/09/2005
- **Last updated:** 08/22/2020