Healthcare Provider Details

I. General information

NPI: 1750582797
Provider Name (Legal Business Name): BAY AREA LASER SURGERY CENTER, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 07/03/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1599 TARA HILLS DR
PINOLE CA
94564-2519
US

IV. Provider business mailing address

1599 TARA HILLS DR
PINOLE CA
94564-2519
US

V. Phone/Fax

Practice location:
  • Phone: 510-724-7629
  • 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: ARMEN SEREBRAKIAN
Title or Position: PARTNER OWNER
Credential: M.D.
Phone: 510-724-7629