Healthcare Provider Details

I. General information

NPI: 1780862896
Provider Name (Legal Business Name): SOUTH BAY SURGERY CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2008
Last Update Date: 03/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15151 NATIONAL AVE
LOS GATOS CA
95032
US

IV. Provider business mailing address

15151 NATIONAL AVE
LOS GATOS CA
95032
US

V. Phone/Fax

Practice location:
  • Phone: 408-358-4845
  • Fax: 408-358-1602
Mailing address:
  • Phone: 408-358-4845
  • Fax: 408-358-1602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. GORDON S. ROSENBERG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 408-356-0431