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General NPI Number Information
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NPI Number | 1801983556
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Entity Type | Organization
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Legal Business Name | TRESANTI SURGICAL CENTER LLC
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 09/13/2024
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Provider Practice Location Address
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Address Line | 5201 NORRIS CANYON ROAD #100
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City | SAN RAMON
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State | CA
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Zip | 94583
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Country | US
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Telephone | 925-973-0605
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Fax | 925-973-0653
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Provider Business Mailing Address
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Address Line | 5201 NORRIS CANYON ROAD #100
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City | SAN RAMON
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State | CA
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Zip | 94583
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Country | US
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Telephone | 925-973-0605
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Fax | 925-973-0653
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Authorized Official
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Title or Position | AUTHORIZED OFFICIAL
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Name | ERIC BOON
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Credential |
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Telephone | 480-567-0269
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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 | 140000665
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License Number State | CA
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