Healthcare Provider Details

I. General information

NPI: 1154728111
Provider Name (Legal Business Name): BAY AREA SURGICAL SPECIALISTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2014
Last Update Date: 11/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 LENNON LN STE 250 SUITE 250
WALNUT CREEK CA
94598-5915
US

IV. Provider business mailing address

365 LENNON LN STE 250 SUITE 250
WALNUT CREEK CA
94598-5915
US

V. Phone/Fax

Practice location:
  • Phone: 925-932-6330
  • Fax: 925-627-3560
Mailing address:
  • Phone: 925-932-6330
  • Fax: 925-627-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA95275
License Number StateCA

VIII. Authorized Official

Name: DAVID PITTMAN
Title or Position: CEO
Credential:
Phone: 925-948-8143