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General NPI Number Information
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NPI Number | 1548741648
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Entity Type | Organization
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Legal Business Name | PACIFIC HEART SURGERY
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Dates
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Enumeration Date | 08/27/2018
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Last Update Date | 11/29/2018
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Provider Practice Location Address
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Address Line | 2 BON AIR RD STE 100
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City | LARKSPUR
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State | CA
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Zip | 94939
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Country | US
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Telephone | 415-269-0001
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Fax |
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Provider Business Mailing Address
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Address Line | 19201 SONOMA HIGHWAY #308
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City | SONOMA
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State | CA
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Zip | 95476
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | MARSHA SUMMERS
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Credential |
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Telephone | 480-479-0909
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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 | G45518
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License Number State | CA
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