Healthcare Provider Details

I. General information

NPI: 1154888246
Provider Name (Legal Business Name): BAY AREA SURGICAL SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2019
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2914 W MAIN ST
VISALIA CA
93291-5731
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 559-627-2849
  • Fax: 559-627-9772
Mailing address:
  • Phone: 925-948-8143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

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