Healthcare Provider Details

I. General information

NPI: 1427166990
Provider Name (Legal Business Name): LOS ALTOS SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2006
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 ALTOS OAKS DR
LOS ALTOS CA
94024-5428
US

IV. Provider business mailing address

1871 MARTIN AVE
SANTA CLARA CA
95050-2501
US

V. Phone/Fax

Practice location:
  • Phone: 650-209-5894
  • Fax: 650-209-1110
Mailing address:
  • Phone: 650-941-8888
  • Fax: 650-209-1110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number220000309
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. BARBARA LEE ROTH
Title or Position: VICE PRESIDENT
Credential: REGISTERED NURSE
Phone: 408-761-5847