Healthcare Provider Details

I. General information

NPI: 1427061696
Provider Name (Legal Business Name): CUESTA PARK ENDOSCOPY CENTER LP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204 GRANT ROAD #104
MOUNTAIN VIEW CA
94040
US

IV. Provider business mailing address

PO BOX 39000 DEPT 33691-10
SAN FRANCISCO CA
94139
US

V. Phone/Fax

Practice location:
  • Phone: 650-938-1411
  • Fax: 650-969-3772
Mailing address:
  • Phone: 650-493-7729
  • Fax: 650-493-7959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SAMUEL N MARCUS
Title or Position: CO FOUNDER
Credential: MD PHD
Phone: 650-496-4141