# MODESTO SURGERY CENTER LLC

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

## Provider details

- **NPI number:** 1356463913
- **Authorized official:** CHERYL ELAINE BONELLI (CORPORATE ADMINISTRATOR)
- **Authorized official phone:** (760) 685-4096

## Contact information

- **Practice address:** 400 E ORANGEBURG AVE STE 1, MODESTO, CA 95350-5342
- **Practice address phone:** (209) 526-3000
- **Practice address fax:** (209) 526-3133
- **Mailing address:** 400 E ORANGEBURG AVE STE 1, MODESTO, CA 95350-5342
- **Mailing address phone:** (209) 526-3000
- **Mailing address fax:** (209) 526-3133

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 030000552 | CA | Yes |

## Other

- **Enumeration date:** 04/04/2007
- **Last updated:** 12/28/2021