Healthcare Provider Details

I. General information

NPI: 1710543467
Provider Name (Legal Business Name): BAY AREA SURGICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2019
Last Update Date: 05/17/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 E HACIENDA AVE STE B
CAMPBELL CA
95008-6625
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 408-376-3350
  • Fax: 408-374-4130
Mailing address:
  • Phone: 925-948-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: GREGORY A RHODES
Title or Position: AUTHORIZED OFFICIAL/PRESIDENT
Credential: MD
Phone: 925-932-6330