Healthcare Provider Details

I. General information

NPI: 1801039508
Provider Name (Legal Business Name): HJ SURGERY CENTER INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2009
Last Update Date: 08/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13690 E 14TH ST STE 200
SAN LEANDRO CA
94578-2582
US

IV. Provider business mailing address

13690 E 14TH ST STE 200
SAN LEANDRO CA
94578-2582
US

V. Phone/Fax

Practice location:
  • Phone: 510-614-9200
  • Fax: 510-614-9203
Mailing address:
  • Phone: 510-614-9200
  • Fax: 510-614-9203

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: H DARIEN BEHRAVAN
Title or Position: PRESIDENT
Credential: D.O.
Phone: 510-614-9200