Healthcare Provider Details

I. General information

NPI: 1083171268
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: 02/25/2019
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E ARQUES AVE STE 113
SUNNYVALE CA
94085-5419
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 408-730-8082
  • Fax: 87-300-5484
Mailing address:
  • Phone: 925-948-8143
  • Fax: 925-215-4540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GREGORY A RHODES
Title or Position: PRESIDENT, AUTHORIZED OFFICIAL
Credential: MD
Phone: 925-932-6330