Organization
MODESTO SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHERYL ELAINE BONELLI (CORPORATE ADMINISTRATOR)
(760) 685-4096
Entity
Organization
Contact information
Practice address
400 E ORANGEBURG AVE STE 1, MODESTO, CA 95350-5342
(209) 526-3000
(209) 526-3133
Mailing address
400 E ORANGEBURG AVE STE 1, MODESTO, CA 95350-5342
(209) 526-3000
(209) 526-3133
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
030000552
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SUR01324F
—
CA
Enumeration date
04/04/2007
Last updated
12/28/2021
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