Healthcare Provider Details

I. General information

NPI: 1114091261
Provider Name (Legal Business Name): WILLOW SURGERY CENTER, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 WILLOW ST SUITE 303
SAN FRANCISCO CA
94109-7734
US

IV. Provider business mailing address

203 WILLOW ST SUITE 303
SAN FRANCISCO CA
94109-7734
US

V. Phone/Fax

Practice location:
  • Phone: 415-931-2345
  • Fax: 415-931-6010
Mailing address:
  • Phone: 415-931-2345
  • Fax: 415-931-6010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. RANDALL B. WEIL
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 415-931-2345