Healthcare Provider Details

I. General information

NPI: 1306985932
Provider Name (Legal Business Name): BAY AREA COLON & RECTAL SURGEONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 LENNON LN SUITE 290
WALNUT CREEK CA
94598-5910
US

IV. Provider business mailing address

365 LENNON LN SUITE 290
WALNUT CREEK CA
94598-5910
US

V. Phone/Fax

Practice location:
  • Phone: 925-274-9000
  • Fax: 925-274-9004
Mailing address:
  • Phone: 925-274-9000
  • Fax: 925-274-9004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL C OOMMEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 925-274-9000