Healthcare Provider Details

I. General information

NPI: 1811491624
Provider Name (Legal Business Name): PARK WEST SURGICAL ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2018
Last Update Date: 03/19/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 RALEY BLVD.
CHICO CA
95928
US

IV. Provider business mailing address

PO BOX 34120
RENO NV
89533-4120
US

V. Phone/Fax

Practice location:
  • Phone: 877-747-5050
  • Fax:
Mailing address:
  • Phone: 877-747-5050
  • Fax: 775-747-5005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NIRVANA KUNDU
Title or Position: PRESIDENT
Credential: MD
Phone: 877-747-5050