1841398104 NPI number — SAN RAMON REGIONAL MEDICAL CENTER

Table of content: ROBERT ALLAN SEPERSKY M.D. (NPI 1457328494)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841398104 NPI number — SAN RAMON REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN RAMON REGIONAL MEDICAL CENTER
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:
1841398104
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2057 MAGNOLIA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94595
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-932-1199
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6001 NORRIS CANYON ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN RAMON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94583
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-275-8280
Provider Business Practice Location Address Fax Number:
925-275-8284
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KATZ
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
EMERGENCY DEPARTMENT PHYSICIAN
Authorized Official Telephone Number:
925-275-8280

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  G69003 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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