Healthcare Provider Details

I. General information

NPI: 1710060751
Provider Name (Legal Business Name): BAY AREA SURGICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 LAFAYETTE ST
SANTA CLARA CA
95050-2904
US

IV. Provider business mailing address

2222 LAFAYETTE ST
SANTA CLARA CA
95050-2904
US

V. Phone/Fax

Practice location:
  • Phone: 408-988-0105
  • Fax: 408-988-0112
Mailing address:
  • Phone: 408-988-0105
  • Fax: 408-988-0112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number550000076
License Number StateCA

VIII. Authorized Official

Name: MS. MEGAN NGA NGUYEN
Title or Position: ADMINISTRATOR
Credential:
Phone: 408-988-0105