Healthcare Provider Details

I. General information

NPI: 1053704783
Provider Name (Legal Business Name): PARK WEST SURGICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2015
Last Update Date: 03/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 BUTCHER RD #A
VACAVILLE CA
95687-5656
US

IV. Provider business mailing address

171 BUTCHER RD #A
VACAVILLE CA
95687-5656
US

V. Phone/Fax

Practice location:
  • Phone: 707-474-4433
  • Fax:
Mailing address:
  • Phone: 707-474-4433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: NIRVANA KUNDU
Title or Position: PRESIDENT
Credential: MD
Phone: 530-665-3212