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General NPI Number Information
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NPI Number | 1821167628
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Entity Type | Organization
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Legal Business Name | MINIMALLY INVASIVE SURGICAL SOLUTIONS MEDICAL CORPORATION
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Dates
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Enumeration Date | 11/07/2006
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Last Update Date | 06/10/2025
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Provider Practice Location Address
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Address Line | 105 N BASCOM AVE STE 104
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City | SAN JOSE
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State | CA
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Zip | 95128-1811
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Country | US
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Telephone | 408-918-0405
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Fax | 408-918-0409
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Provider Business Mailing Address
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Address Line | 105 N BASCOM AVE STE 104
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City | SAN JOSE
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State | CA
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Zip | 95128-1811
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Country | US
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Telephone | 408-918-0405
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Fax | 408-918-0409
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | MS. MARIA ANDRADE
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Credential |
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Telephone | 408-918-0405
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number |
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License Number State |
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