Organization
ENT FACIAL SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA VAINAUSKAS (DIRECTOR OF NURSING)
(559) 432-3724
Entity
Organization
Contact information
Practice address
1351 E SPRUCE AVE, FRESNO, CA 93720-3342
(559) 432-3303
(559) 432-1468
Mailing address
1351 E SPRUCE AVE, FRESNO, CA 93720-3342
(559) 432-3303
(559) 432-1468
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SURG01199F
—
CA
Enumeration date
03/21/2006
Last updated
02/27/2018
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