Healthcare Provider Details

I. General information

NPI: 1467717702
Provider Name (Legal Business Name): EL CAMINO AMBULATORY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2012
Last Update Date: 07/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 GRANT RD
MOUNTAIN VIEW CA
94040-4333
US

IV. Provider business mailing address

375 FOREST AVE
PALO ALTO CA
94301-2521
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: CAROLE WILSON
Title or Position: CEO
Credential:
Phone: 650-289-1655