Healthcare Provider Details

I. General information

NPI: 1619485695
Provider Name (Legal Business Name): BAY AREA SURGICAL SPECIALISTS INC A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2018
Last Update Date: 01/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2242 CAMINO RAMON STE 100
SAN RAMON CA
94583-1363
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 925-327-0015
  • Fax: 925-327-0095
Mailing address:
  • Phone: 925-948-8143
  • Fax: 925-215-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: BONNIE POTTER
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 925-948-8143