Healthcare Provider Details

I. General information

NPI: 1225385883
Provider Name (Legal Business Name): SKIN CANCER CENTER OF SILICON VALLEY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 11/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 POLLARD RD BLDG A
LOS GATOS CA
95032
US

IV. Provider business mailing address

PO BOX 3444
SARATOGA CA
95070-1444
US

V. Phone/Fax

Practice location:
  • Phone: 408-688-2082
  • Fax:
Mailing address:
  • Phone: 408-688-2082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberG41972
License Number StateCA

VIII. Authorized Official

Name: STEVEN L. SWENGEL
Title or Position: OWNER
Credential: MD
Phone: 408-688-2082