Healthcare Provider Details

I. General information

NPI: 1972159366
Provider Name (Legal Business Name): BAY AREA SURGICAL SPECIALISTS INC A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2019
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6061 N 1ST ST STE 103
FRESNO CA
93710-5470
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 559-436-8262
  • Fax: 559-436-0444
Mailing address:
  • Phone: 925-948-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: GREGORY A RHODES
Title or Position: AUTHORIZED OFFICIAL, PRESIDENT
Credential: MD
Phone: 925-932-6330