Healthcare Provider Details

I. General information

NPI: 1508818634
Provider Name (Legal Business Name): MONTEREY BAY ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 UPPER RAGSDALE DR SUITE 100
MONTEREY CA
93940-7849
US

IV. Provider business mailing address

23 UPPER RAGSDALE DR SUITE 100
MONTEREY CA
93940-7849
US

V. Phone/Fax

Practice location:
  • Phone: 831-375-3577
  • Fax: 831-375-1478
Mailing address:
  • Phone: 831-375-3577
  • Fax: 831-375-1478

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number070000315
License Number StateCA

VIII. Authorized Official

Name: SUZANNE J GREEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 831-375-3577