MEDICARE: DIABLO MOUNTAIN AMBULATORY SURGERY CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center

General Provider Information

NPI Number	:	1558850958
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIABLO MOUNTAIN AMBULATORY SURGERY CENTER

Provider Business Mailing Address
First Line	:	100 PARK PL STE 110
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-4460
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PARK PL STE 110
Second Line	:
City	:	SAN RAMON
State	:	CA
Zip	:	94583-4460
Country	:	US
Telephone Number	:	925-462-3020
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	CINDY JAMES
Credential	:
Telephone Number	:	925-462-3020

Provider Enumeration Date	:	05/02/2018
Last Update Date	:	05/04/2021

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