Healthcare Provider Details

I. General information

NPI: 1285612812
Provider Name (Legal Business Name): ENDOSCOPY CENTER OF SILICON VALLEY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 04/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SAMARITAN DR 101
SAN JOSE CA
95124
US

IV. Provider business mailing address

2410 SAMARITAN DR 101
SAN JOSE CA
95124
US

V. Phone/Fax

Practice location:
  • Phone: 408-369-9798
  • Fax: 408-369-9895
Mailing address:
  • Phone: 408-369-9798
  • Fax: 408-369-9895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QE0800X
TaxonomyEndoscopy Clinic/Center
License Number070000622
License Number StateCA

VIII. Authorized Official

Name: MRS. SONJA C VON AHMEN
Title or Position: CLINICAL DIRECTOR
Credential: RN
Phone: 408-369-9798