Healthcare Provider Details

I. General information

NPI: 1295238442
Provider Name (Legal Business Name): NORTHERN CALIFORNIA INTEGRATED SURGEONS, MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2018
Last Update Date: 03/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2750 ROHRER DR
LAFAYETTE CA
94549-5753
US

IV. Provider business mailing address

2750 ROHRER DR
LAFAYETTE CA
94549-5753
US

V. Phone/Fax

Practice location:
  • Phone: 520-907-4776
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN FRIEND
Title or Position: EXECUTIVE
Credential:
Phone: 520-907-4776