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General NPI Number Information
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NPI Number | 1972490399
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Entity Type | Organization
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Legal Business Name | EAST BAY SURGICAL CENTER LLC
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Dates
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Enumeration Date | 06/19/2025
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Last Update Date | 06/19/2025
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Provider Practice Location Address
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Address Line | 13847 E 14TH ST STE 116
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City | SAN LEANDRO
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State | CA
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Zip | 94578-2625
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Country | US
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Telephone | 818-855-1507
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Fax |
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Provider Business Mailing Address
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Address Line | 425 15TH ST UNIT 3195
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City | MANHATTAN BEACH
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State | CA
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Zip | 90266-7316
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Country | US
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Telephone | 818-855-1507
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DANIEL ROSHAN
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Credential | MD
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Telephone | 310-415-1047
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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 |
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