Healthcare Provider Details

I. General information

NPI: 1952466716
Provider Name (Legal Business Name): EL CAMINO SURGERY CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 GRANT RD
MOUNTAIN VIEW CA
94040-4300
US

IV. Provider business mailing address

2480 GRANT RD
MOUNTAIN VIEW CA
94040-4300
US

V. Phone/Fax

Practice location:
  • Phone: 650-961-1200
  • Fax: 650-960-7041
Mailing address:
  • Phone: 650-961-1200
  • Fax: 650-960-7041

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number220000
License Number StateCA

VIII. Authorized Official

Name: MRS. LISA COOPER
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 650-961-1200