Healthcare Provider Details

I. General information

NPI: 1124031406
Provider Name (Legal Business Name): SAN FRANCISCO ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2006
Last Update Date: 07/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3468 CALIFORNIA STREET
SAN FRANCISCO CA
94118
US

IV. Provider business mailing address

PO BOX 4323
MOUNTAIN VIEW CA
94040
US

V. Phone/Fax

Practice location:
  • Phone: 415-345-0100
  • Fax: 415-345-0107
Mailing address:
  • Phone: 650-493-7729
  • Fax: 650-493-7959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number220000489
License Number StateCA

VIII. Authorized Official

Name: SAMUEL N MARCUS
Title or Position: CO-FOUNDER
Credential: MD PH D
Phone: 650-496-4141