Healthcare Provider Details

I. General information

NPI: 1740642230
Provider Name (Legal Business Name): WILLOW SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2016
Last Update Date: 03/23/2016
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: 415-928-1206
  • Fax: 415-928-1208
Mailing address:
  • Phone: 415-928-1206
  • Fax: 415-928-1208

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: RYAN DAVID
Title or Position: CLINICAL DIRECTOR
Credential: RN
Phone: 415-821-8015