Provider Demographics
NPI:1316001738
Name:RINALDI SURGERY CENTER LLC
Entity type:Organization
Organization Name:RINALDI SURGERY CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:831-588-7296
Mailing Address - Street 1:10200 TRINITY PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95219-7286
Mailing Address - Country:US
Mailing Address - Phone:818-838-0400
Mailing Address - Fax:818-838-0420
Practice Address - Street 1:10200 TRINITY PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95219-7286
Practice Address - Country:US
Practice Address - Phone:818-838-0400
Practice Address - Fax:818-838-0420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA09203114275890261Q00000X, 261QA1903X
CAS051323261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADZ692AMedicare PIN
CA05C0001323Medicare ID - Type UnspecifiedMEDICARE ID NUMBER