Healthcare Provider Details

I. General information

NPI: 1609274505
Provider Name (Legal Business Name): BAY AREA SURGICAL SPECIALIST SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/09/2014
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 N WIGET LN
WALNUT CREEK CA
94598-2408
US

IV. Provider business mailing address

2637 SHADELANDS DR
WALNUT CREEK CA
94598-2512
US

V. Phone/Fax

Practice location:
  • Phone: 925-378-4949
  • Fax: 925-949-8214
Mailing address:
  • Phone: 925-948-8143
  • Fax: 925-215-4540

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: ERIC BOON
Title or Position: OFFICER / AUTHORIZED OFFICIAL
Credential:
Phone: 202-815-3665