Healthcare Provider Details

I. General information

NPI: 1902187099
Provider Name (Legal Business Name): EAST BAY AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1860 MOWRY AVE SUITE 401 / 402
FREMONT CA
94538-1730
US

IV. Provider business mailing address

9001 WILSHIRE BLVD SUITE 106
BEVERLY HILLS CA
90211-1838
US

V. Phone/Fax

Practice location:
  • Phone: 510-713-0700
  • Fax: 510-713-0701
Mailing address:
  • Phone: 310-714-1888
  • 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: MS. CINDY OMIDI
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 310-714-1888