Healthcare Provider Details

I. General information

NPI: 1609938570
Provider Name (Legal Business Name): LASER SURGERY CENTER OF NORTHERN CALIFORNIA LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 12/18/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2021 YGNACIO VALLEY RD BLDG H STE 102
WALNUT CREEK CA
94598
US

IV. Provider business mailing address

2021 YGNACIO VALLEY RD BLDG H STE 102
WALNUT CREEK CA
94598
US

V. Phone/Fax

Practice location:
  • Phone: 925-944-9400
  • Fax: 925-947-2160
Mailing address:
  • Phone: 925-944-9400
  • Fax: 925-947-2160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. MICHELE E MCKINLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 925-944-9400