Healthcare Provider Details

I. General information

NPI: 1205839636
Provider Name (Legal Business Name): BAY AREA SURGICAL ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 GREGORY LN STE 204
PLEASANT HILL CA
94523-2842
US

IV. Provider business mailing address

401 GREGORY LN STE 204
PLEASANT HILL CA
94523-2842
US

V. Phone/Fax

Practice location:
  • Phone: 925-798-4606
  • Fax: 925-798-4671
Mailing address:
  • Phone: 925-798-4606
  • Fax: 925-798-4671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA43945
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberG54054
License Number StateCA

VIII. Authorized Official

Name: MS. LISA P WOOD
Title or Position: PRACTICE MANAGER
Credential:
Phone: 925-798-4607