Healthcare Provider Details

I. General information

NPI: 1023370251
Provider Name (Legal Business Name): O'CONNOR BUILDING SURGERY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2012
Last Update Date: 06/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CIRO AVE SUITE 110
SAN JOSE CA
95128-1671
US

IV. Provider business mailing address

125 CIRO AVE SUITE 110
SAN JOSE CA
95128-1671
US

V. Phone/Fax

Practice location:
  • Phone: 408-761-5847
  • Fax: 408-988-0112
Mailing address:
  • Phone: 408-761-5847
  • Fax: 408-988-0112

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: MS. BARBARA LEE ROTH
Title or Position: REGIONAL DIRECTOR
Credential: RN
Phone: 408-761-5847