Healthcare Provider Details

I. General information

NPI: 1376903153
Provider Name (Legal Business Name): BAY AREA SURGICAL SPECIALISTS, INC A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2016
Last Update Date: 03/09/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROWLAND WAY SUITE 200
NOVATO CA
94945-5011
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 415-878-0255
  • Fax: 925-287-0913
Mailing address:
  • Phone: 925-627-3424
  • Fax: 925-627-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: INEZ WONDEH
Title or Position: COO
Credential:
Phone: 925-948-8143