Healthcare Provider Details

I. General information

NPI: 1790231256
Provider Name (Legal Business Name): GOLDEN GATE SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2016
Last Update Date: 02/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 SUTTER ST 5TH FL
SAN FRANCISCO CA
94108-4206
US

IV. Provider business mailing address

490 POST ST STE 900
SAN FRANCISCO CA
94102-1401
US

V. Phone/Fax

Practice location:
  • Phone: 415-409-1367
  • Fax: 415-896-4922
Mailing address:
  • Phone: 415-409-1367
  • Fax: 415-896-4922

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA050788
License Number StateCA

VIII. Authorized Official

Name: DR. NICHOLAS COLYVAS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 415-409-1367