Healthcare Provider Details

I. General information

NPI: 1255620639
Provider Name (Legal Business Name): SILICON VALLEY AMBULATORY SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2011
Last Update Date: 04/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 CIRO AVE STE 101 & 110
SAN JOSE CA
95128-1671
US

IV. Provider business mailing address

369 S DOHENY DR STE 169
BEVERLY HILLS CA
90211-3577
US

V. Phone/Fax

Practice location:
  • Phone: 424-249-3783
  • Fax: 866-851-2648
Mailing address:
  • Phone: 424-249-3783
  • Fax: 866-851-2648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA84519
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberA84519
License Number StateCA

VIII. Authorized Official

Name: CAROUSEL CASTILLO
Title or Position: ADMINISTRATOR
Credential: BSCS, BSN
Phone: 424-249-3783