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General NPI Number Information
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NPI Number | 1316395395
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Entity Type | Organization
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Legal Business Name | SACRAMENTO ADVANCED LAPAROSCOPIC SURGERY
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Dates
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Enumeration Date | 05/31/2016
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Last Update Date | 03/29/2024
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Provider Practice Location Address
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Address Line | 110 JENSEN CT SUITE 1B
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7483
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Country | US
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Telephone | 805-230-0030
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Fax | 805-230-2995
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Provider Business Mailing Address
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Address Line | 110 JENSEN CT SUITE 1B
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City | THOUSAND OAKS
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State | CA
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Zip | 91360-7483
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Country | US
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Telephone | 805-230-0030
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Fax | 805-230-2995
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Authorized Official
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Title or Position | MD / CEO
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Name | DR. DONALD WALDREP
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Credential | MD
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Telephone | 805-230-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | G75982
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License Number State | CA
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