Healthcare Provider Details

I. General information

NPI: 1992529705
Provider Name (Legal Business Name): SURGICAL INTERVENTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2024
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13851 E 14TH ST STE 202
SAN LEANDRO CA
94578-2627
US

IV. Provider business mailing address

13851 E 14TH ST STE 202
SAN LEANDRO CA
94578-2627
US

V. Phone/Fax

Practice location:
  • Phone: 510-357-4006
  • Fax:
Mailing address:
  • Phone: 510-357-4006
  • 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: DR. MICHAEL DAVID INGEGNO
Title or Position: MBR
Credential: MD
Phone: 510-599-7750