Healthcare Provider Details

I. General information

NPI: 1821536954
Provider Name (Legal Business Name): WEBSTER SURGERY CENTER, LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 02/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20998 REDWOOD DR
CASTRO VALLEY CA
94546
US

IV. Provider business mailing address

80 GRAND AVE SUITE 250
OAKLAND CA
94612-3725
US

V. Phone/Fax

Practice location:
  • Phone: 510-576-8525
  • Fax: 510-576-0248
Mailing address:
  • Phone: 510-451-1875
  • Fax: 510-839-9588

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. GLEN K. LAU
Title or Position: GENERAL PARTNER
Credential: M.D.
Phone: 510-451-1875