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General NPI Number Information
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NPI Number | 1952698078
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Entity Type | Organization
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Legal Business Name | EXECUTIVE SURGERY CENTER, INC.
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Dates
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Enumeration Date | 07/10/2011
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Last Update Date | 04/20/2012
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Provider Practice Location Address
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Address Line | 1320 EL CAPITAN DR SUITE 100
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City | DANVILLE
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State | CA
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Zip | 94526-6258
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Country | US
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Telephone | 925-963-0759
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Fax |
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Provider Business Mailing Address
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Address Line | 1320 EL CAPITAN DR SUITE 100
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City | DANVILLE
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State | CA
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Zip | 94526-6258
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Country | US
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Telephone | 925-963-0759
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. SALIM SHELBY
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Credential | M.D.
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Telephone | 925-963-0759
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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 | A69275
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License Number State | CA
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