Healthcare Provider Details

I. General information

NPI: 1972490399
Provider Name (Legal Business Name): EAST BAY SURGICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2025
Last Update Date: 06/19/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13847 E 14TH ST STE 116
SAN LEANDRO CA
94578-2625
US

IV. Provider business mailing address

425 15TH ST UNIT 3195
MANHATTAN BEACH CA
90266-7316
US

V. Phone/Fax

Practice location:
  • Phone: 818-855-1507
  • Fax:
Mailing address:
  • Phone: 818-855-1507
  • Fax:

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: DANIEL ROSHAN
Title or Position: CEO
Credential: MD
Phone: 310-415-1047