Provider Demographics
NPI:1316674518
Name:PALM BLUFFS SURGERY CENTER LLC
Entity type:Organization
Organization Name:PALM BLUFFS SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:PRIETO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:559-906-0209
Mailing Address - Street 1:7766 N PALM AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-5704
Mailing Address - Country:US
Mailing Address - Phone:559-439-5300
Mailing Address - Fax:559-412-2645
Practice Address - Street 1:7766 N PALM AVE # 104
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-5734
Practice Address - Country:US
Practice Address - Phone:559-439-5300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-07
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical