Healthcare Provider Details

I. General information

NPI: 1891138301
Provider Name (Legal Business Name): BURLINGAME SURGICAL CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2013
Last Update Date: 04/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 EL CAMINO REAL
BURLINGAME CA
94010-3228
US

IV. Provider business mailing address

27087 GRATIOT AVE 2ND FL
ROSEVILLE MI
48066-2947
US

V. Phone/Fax

Practice location:
  • Phone: 650-259-1480
  • Fax: 650-697-7361
Mailing address:
  • Phone: 586-350-2655
  • Fax: 586-498-9439

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOHN CONNOLLY
Title or Position: OWNER
Credential: M.D.
Phone: 650-259-1480