Healthcare Provider Details

I. General information

NPI: 1851568067
Provider Name (Legal Business Name): WALNUT CREEK ENDOSCOPY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 05/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 LENNON LN STE 100
WALNUT CREEK CA
94598-5911
US

IV. Provider business mailing address

730 DISTEL DR
LOS ALTOS CA
94022-1521
US

V. Phone/Fax

Practice location:
  • Phone: 650-331-4662
  • Fax: 866-408-1090
Mailing address:
  • Phone: 650-331-4650
  • 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: SAMUEL N MARCUS
Title or Position: CO-FOUNDER
Credential: MD, PHD
Phone: 650-331-4650