Palm Bluffs Surgery Center LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

PALM BLUFFS SURGERY CENTER LLC

Practice address

7766 N Palm Ave # 104
Fresno, CA 93711-5734

Phone

(559) 439-5300

NPI assigned

Aug 7, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jordan David Prieto, DDS

Title

Owner

Phone

(559) 906-0209

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Ambulatory surgical center certification: CCN 55C0001173

Legal name

Palm Bluffs Surgery Center LLC

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Apr 3, 2024

Last certification

Apr 25, 2024

Facility address

7766 N. Palm Ave Suite 104
Fresno, CA 93711

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1659830400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1743552000000",
    "number": "1316674518",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7766 N PALM AVE STE 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937115704",
            "telephone_number": "559-439-5300",
            "fax_number": "559-412-2645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7766 N PALM AVE # 104",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937115734",
            "telephone_number": "559-439-5300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7766 N Palm Ave Ste 105",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937115734",
            "country_code": "US",
            "telephone_number": "559-439-5300",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PALM BLUFFS SURGERY CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-08-07",
        "last_updated": "2025-04-02",
        "certification_date": "2025-04-02",
        "status": "A",
        "authorized_official_last_name": "PRIETO",
        "authorized_official_first_name": "JORDAN",
        "authorized_official_middle_name": "DAVID",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "559-906-0209",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vishal Pall, MD
• Cheyenne Marie Pallares, MSW
• Meliton V. Pallares Jr., RN
• Veronica Pallaya
• Palm Bluffs Dental Group, Inc. Practice of Dr. Prieto
• Palm Medical Group, Inc
• Candelaria Palma
• Jolina Ruth Ramona Palma
• Raul Palma, MSW
• Cameron Nathaniel Palmer

• Ambulatory Surgical Clinic/Center in Fresno, CA
• Providers in Fresno, CA by specialty
• Ambulatory Surgical Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.