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General NPI Number Information
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NPI Number | 1396741807
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Entity Type | Organization
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Legal Business Name | EAST BAY ENDOSCOPY CENTER L P
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 04/26/2024
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Provider Practice Location Address
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Address Line | 5858 HORTON ST STE 100
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City | EMERYVILLE
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State | CA
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Zip | 94608-2007
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Country | US
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Telephone | 510-654-4554
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Fax | 510-654-4594
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Provider Business Mailing Address
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Address Line | 5858 HORTON ST SUITE 100
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City | EMERYVILLE
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State | CA
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Zip | 94608-2006
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Country | US
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Telephone | 510-654-4554
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | BRADLEY HEATON
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Credential |
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Telephone | 916-566-4907
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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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