Healthcare Provider Details

I. General information

NPI: 1982960084
Provider Name (Legal Business Name): EAST BAY TRAUMA & ACUTE CARE SURGERY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19845 LAKE CHABOT RD 200
CASTRO VALLEY CA
94546-4055
US

IV. Provider business mailing address

19845 LAKE CHABOT ROAD 200
CASTRO VALLEY CA
94546-4055
US

V. Phone/Fax

Practice location:
  • Phone: 510-538-5500
  • Fax: 510-538-5505
Mailing address:
  • Phone: 510-538-5500
  • Fax: 510-538-5505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA87104
License Number StateCA

VIII. Authorized Official

Name: DR. SABA AZIMI
Title or Position: DIRECTOR
Credential: MD
Phone: 510-538-5500