Healthcare Provider Details

I. General information

NPI: 1255793758
Provider Name (Legal Business Name): MISSION SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 04/15/2025
Certification Date: 04/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38437 MISSION BLVD SUITE 102
FREMONT CA
94536-4318
US

IV. Provider business mailing address

38437 MISSION BLVD
FREMONT CA
94536-4318
US

V. Phone/Fax

Practice location:
  • Phone: 510-366-6286
  • Fax:
Mailing address:
  • Phone: 510-366-6286
  • Fax:

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: TULSIDAS GWALANI
Title or Position: MEDICAL DIRECTOR/OWNER
Credential: MD
Phone: 510-818-9237