Organization
COFFEE ROAD SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ERIC BOON (OFFICER/AO)
(480) 567-0269
Entity
Organization
Contact information
Practice address
1335 COFFEE RD STE 201, MODESTO, CA 95355-3192
(209) 492-0483
Mailing address
1335 COFFEE RD STE 201, MODESTO, CA 95355-3192
(209) 492-0483
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
09/27/2024
Last updated
05/08/2026
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