Healthcare Provider Details

I. General information

NPI: 1144259870
Provider Name (Legal Business Name): BLACKHAWK SURGERY CENTER, A MEDICAL CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 10/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 BLACKHAWK PLAZA CIRCLE
DANVILLE CA
94506
US

IV. Provider business mailing address

11999 SAN VICENTE BL. # 440
LOS ANGELES CA
90049
US

V. Phone/Fax

Practice location:
  • Phone: 925-736-5757
  • Fax: 925-736-5763
Mailing address:
  • Phone: 310-440-3131
  • Fax: 310-472-9582

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. STEPHEN J. RONAN
Title or Position: OWNER
Credential: M.D.
Phone: 925-736-5757