1629730395 NPI number — NORTH BAY AMBULATORY SURGERY CENTER (NBASC) LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629730395 NPI number — NORTH BAY AMBULATORY SURGERY CENTER (NBASC) LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH BAY AMBULATORY SURGERY CENTER (NBASC) LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1629730395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1312
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS GATOS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95031-1312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-828-5973
Provider Business Mailing Address Fax Number:
866-284-9263

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1850 SULLIVAN AVE STE 400
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALY CITY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94015-2204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-991-6442
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
VIALE
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
408-828-5973

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com