Healthcare Provider Details

I. General information

NPI: 1871826925
Provider Name (Legal Business Name): SUTTER BAY HOSPITALS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2009
Last Update Date: 01/20/2022
Certification Date: 01/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1580 VALENCIA STREET SUITE 506
SAN FRANCISCO CA
94110-4418
US

IV. Provider business mailing address

PO BOX 60000 FILE 74175
SAN FRANCISCO CA
94160-0001
US

V. Phone/Fax

Practice location:
  • Phone: 415-647-8111
  • Fax: 415-641-6831
Mailing address:
  • Phone: 415-641-2177
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number550000230
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number550000228
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number220000097
License Number StateCA

VIII. Authorized Official

Name: MR. JOHN B. GATES
Title or Position: CFO
Credential:
Phone: 510-450-7357