COFFEE ROAD SURGERY CENTER, LLC
NPI 1134947328
Clinic/Center - Ambulatory Surgical in Modesto, CA
About Coffee Road Surgery Center, Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
COFFEE ROAD SURGERY CENTER, LLC (NPI 1134947328) is a healthcare organization registered as an ambulatory surgical in Modesto, California and active in the NPI registry since September 2024. The organization holds a CLIA Waiver certificate valid through May 13, 2027 and lists Eric Boon, Officer/ao, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
CLIA Laboratory Certificates CMS CLIA
Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.
Certificate of Waiver 05D2096010
Coffee Road Surgery Center LLC · Modesto, CAFrequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Coffee Road Surgery Center, LLC's NPI number?
The NPI number for Coffee Road Surgery Center, LLC is 1134947328. It was assigned to this organization in the NPPES registry on September 27, 2024.
Where is Coffee Road Surgery Center, LLC located?
Coffee Road Surgery Center, LLC is located at 1335 Coffee Rd Ste 201, Modesto, CA 95355. The listed phone number is (209) 492-0483.
What is Coffee Road Surgery Center, LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center, specializing in Ambulatory Surgical, with taxonomy code 261QA1903X.
Does Coffee Road Surgery Center, LLC hold a CLIA laboratory certificate?
Yes. A Certificate of Waiver (number 05D2096010) is associated with this NPI, valid through May 13, 2027. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.
When was this NPI record last updated?
The NPPES record for Coffee Road Surgery Center, LLC was last updated on May 8, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Coffee Road Surgery Center, Llc · NPI 1134947328
Ambulatory Surgical organization in Modesto, California. Organization record, active in the CMS NPPES registry since September 27, 2024.
## Identity
- **NPI:** 1134947328 (Entity type: Organization)
- **Enumerated:** September 27, 2024
- **Primary specialty:** Clinic/Center - Ambulatory Surgical · taxonomy 261QA1903X
- **Organization subpart:** No
- **Authorized official:** Eric Boon, OFFICER/AO
## Practice location
- **Address:** 1335 COFFEE RD STE 201, Modesto, CA 95355-3192
- **Phone:** (209) 492-0483
## Record status
- **NPPES last updated:** May 8, 2026
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1134947328) · Data from the CMS NPPES public registry.