Healthcare Provider Details

I. General information

NPI: 1043616600
Provider Name (Legal Business Name): BAY AREA SURGICAL SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 N WIGET LN STE 100
WALNUT CREEK CA
94598-2450
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 925-944-0110
  • Fax: 925-944-0960
Mailing address:
  • Phone: 925-948-8143
  • Fax: 925-627-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberA42343
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA42343
License Number StateCA

VIII. Authorized Official

Name: INEZ WONDEH
Title or Position: CEO
Credential:
Phone: 925-948-8143