Healthcare Provider Details

I. General information

NPI: 1285364182
Provider Name (Legal Business Name): ADVANCED SURGICAL CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 10/10/2022
Certification Date: 10/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

236 W 6TH ST STE 400
RENO NV
89503-4553
US

IV. Provider business mailing address

9726 QUARTETTE DR
RENO NV
89521-3217
US

V. Phone/Fax

Practice location:
  • Phone: 775-475-9881
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: ASHANGA YATAWATTA
Title or Position: OWNER
Credential: MD FACS
Phone: 725-400-3200