Healthcare Provider Details

I. General information

NPI: 1194835686
Provider Name (Legal Business Name): EAST BAY ENDOSURGERY CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 11/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FRANK OGAWA PLAZA SUITE 135
OAKLAND CA
94612
US

IV. Provider business mailing address

3300 WEBSTER ST SUITE 308
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-893-1600
  • Fax: 510-893-2600
Mailing address:
  • Phone: 510-763-3379
  • Fax: 510-763-3792

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: MR. CHRISTOPHER A HOLDEN
Title or Position: PRESIDENT OF GENERAL PARTNER
Credential:
Phone: 615-665-1283