Organization
AMADOR SURGERY CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DAVID DUTRA DPM (PRESIDENT)
(209) 223-5938
Entity
Organization
Contact information
Practice address
223 CLINTON ROAD, SUITE 204, JACKSON, CA 95642-2680
(209) 223-5938
(209) 257-1599
Mailing address
223 CLINTON ROAD, SUITE 204, JACKSON, CA 95642-2680
(209) 223-5938
(209) 257-1599
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
141370XX
PREFERRED CARE
CA
01
—
2116688
FIRST HEALTH
CA
01
—
5539103
CCN
CA
01
—
AS1640
BLUE CROSS
CA
05
—
SUR01640F
—
CA
Enumeration date
05/03/2006
Last updated
04/20/2008
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