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General NPI Number Information
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NPI Number | 1114091261
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Entity Type | Organization
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Legal Business Name | WILLOW SURGERY CENTER, A MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 203 WILLOW ST SUITE 303
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-7734
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Country | US
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Telephone | 415-931-2345
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Fax | 415-931-6010
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Provider Business Mailing Address
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Address Line | 203 WILLOW ST SUITE 303
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City | SAN FRANCISCO
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State | CA
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Zip | 94109-7734
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Country | US
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Telephone | 415-931-2345
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Fax | 415-931-6010
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RANDALL B. WEIL
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Credential | M.D.
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Telephone | 415-931-2345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State | CA
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