Healthcare Provider Details

I. General information

NPI: 1780996868
Provider Name (Legal Business Name): FREMONT SURGERY CENTER NORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39472 PASEO PADRE PKWY
FREMONT CA
94538-2310
US

IV. Provider business mailing address

39350 CIVIC CENTER DR STE 280
FREMONT CA
94538-2331
US

V. Phone/Fax

Practice location:
  • Phone: 510-456-4600
  • Fax: 510-794-6822
Mailing address:
  • Phone: 510-456-4600
  • Fax: 510-456-1006

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: MR. JOHN MAZOROS
Title or Position: MANAGING PARTNER
Credential:
Phone: 510-456-4600