Healthcare Provider Details

I. General information

NPI: 1891471850
Provider Name (Legal Business Name): BAY SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1610 BLOSSOM HILL RD SUITE 10
SAN JOSE CA
95124
US

IV. Provider business mailing address

3711 LONG BEACH BLVD #4105
LONG BEACH CA
90807
US

V. Phone/Fax

Practice location:
  • Phone: 562-414-4452
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW VARGAS
Title or Position: PRESIDENT
Credential: MD
Phone: 404-502-5594