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General NPI Number Information
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NPI Number | 1982960084
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Entity Type | Organization
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Legal Business Name | EAST BAY TRAUMA & ACUTE CARE SURGERY INC.
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Dates
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Enumeration Date | 04/03/2012
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Last Update Date | 04/03/2012
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Provider Practice Location Address
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Address Line | 19845 LAKE CHABOT RD 200
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4055
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Country | US
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Telephone | 510-538-5500
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Fax | 510-538-5505
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Provider Business Mailing Address
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Address Line | 19845 LAKE CHABOT ROAD 200
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-4055
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Country | US
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Telephone | 510-538-5500
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Fax | 510-538-5505
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. SABA AZIMI
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Credential | MD
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Telephone | 510-538-5500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A87104
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License Number State | CA
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