Healthcare Provider Details

I. General information

NPI: 1972740611
Provider Name (Legal Business Name): WATERMAN SURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 WATERMAN BLVD STE 200
FAIRFIELD CA
94534-2987
US

IV. Provider business mailing address

2801 WATERMAN BLVD STE 200
FAIRFIELD CA
94534-2987
US

V. Phone/Fax

Practice location:
  • Phone: 707-428-3687
  • Fax: 707-422-4327
Mailing address:
  • Phone: 707-428-3687
  • Fax: 707-422-4327

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. WILLIAM TSUN HUEI CHEN
Title or Position: PRESIDENT
Credential: MD
Phone: 707-428-3687