VALHALLA SURGERY CENTER LLC NPI 1811652035

NPI Information

  • NPI: 1811652035
  • Provider Name: VALHALLA SURGERY CENTER, LLC
  • Classification: Clinic/Center - 261QA1903X
  • Specialization: Ambulatory Surgical
  • Entity Type: Organization
  • CLIA Number: 05D2290218
  • Address: 4472 BROAD ST STE 150
    SAN LUIS OBISPO, CA
    ZIP 93401
  • Phone: (805) 364-8450

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NPI Details

VALHALLA SURGERY CENTER, LLC is an ambulatory surgical clinic center in San Luis Obispo, CA. VALHALLA SURGERY CENTER, LLC NPI is 1811652035. The provider is registered as an organization entity type.

The provider's business location address is:

4472 BROAD ST STE 150
SAN LUIS OBISPO, CA
ZIP 93401-990
Phone: (805) 364-8450

The provider's authorized official is Ralph Mozingo .
The authorized official title is Authorized Official and has the following contact phone number (805) 563-0363.

The CLIA number assigned to this NPI record is 05D2290218 - ambulatory surgery center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/2/2021 and was last updated on 12/14/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1261QA1903XClinic/CenterAmbulatory SurgicalYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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