Healthcare Provider Details

I. General information

NPI: 1609915230
Provider Name (Legal Business Name): PACIFIC SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 TAMAL VISTA BLVD STE 103
CORTE MADERA CA
94925-1133
US

IV. Provider business mailing address

21 TAMAL VISTA BLVD STE 103
CORTE MADERA CA
94925-1133
US

V. Phone/Fax

Practice location:
  • Phone: 415-927-7660
  • Fax: 415-927-7663
Mailing address:
  • Phone: 415-927-7660
  • Fax: 415-927-7663

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: DR. TANCREDI D'AMORE
Title or Position: OWNER
Credential: M.D.
Phone: 415-927-7660