Healthcare Provider Details

I. General information

NPI: 1235591496
Provider Name (Legal Business Name): NORTHERN CALIFORNIA SURGICAL ENDOSCOPY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2016
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 MOUNTAIN WOOD LN
WOODSIDE CA
94062-2523
US

IV. Provider business mailing address

240 MOUNTAIN WOOD LN
WOODSIDE CA
94062-2523
US

V. Phone/Fax

Practice location:
  • Phone: 650-327-8778
  • Fax: 650-327-2794
Mailing address:
  • Phone: 650-327-8778
  • Fax: 650-327-2794

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA34341
License Number StateCA

VIII. Authorized Official

Name: DR. CAMRAN NEZHAT
Title or Position: PRESIDENT
Credential: M.D.
Phone: 650-327-8778