Healthcare Provider Details

I. General information

NPI: 1720300312
Provider Name (Legal Business Name): DELTA BAY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2010
Last Update Date: 01/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E 5TH ST SUITE 200
BENICIA CA
94510-3502
US

IV. Provider business mailing address

PO BOX 5668
WALNUT CREEK CA
94596-1668
US

V. Phone/Fax

Practice location:
  • Phone: 707-745-5500
  • Fax: 707-745-5501
Mailing address:
  • Phone: 707-745-3112
  • Fax: 707-745-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number10BUS-00143
License Number StateCA

VIII. Authorized Official

Name: DR. ARUN ANAND
Title or Position: PRESIDENT
Credential: M.D.
Phone: 707-748-7248