Healthcare Provider Details

I. General information

NPI: 1831102003
Provider Name (Legal Business Name): GILROY ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9460 NO NAME UNO SUITE 130
GILROY CA
95020
US

IV. Provider business mailing address

9460 N NAME UNO STE 130
GILROY CA
95020-3532
US

V. Phone/Fax

Practice location:
  • Phone: 408-847-1311
  • Fax: 408-847-1322
Mailing address:
  • Phone: 408-847-1311
  • Fax: 408-847-1322

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. PRINCE SHAH
Title or Position: OWNER
Credential: MD
Phone: 408-847-1311