1407116361 NPI number — MONTEREY PENINSULA SURGERY CENTER CAPITOLA

Table of content: (NPI 1407116361)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407116361 NPI number — MONTEREY PENINSULA SURGERY CENTER CAPITOLA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTEREY PENINSULA SURGERY CENTER CAPITOLA
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:
6
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:
1407116361
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
966 CASS ST
Provider Second Line Business Mailing Address:
SUITE 150
Provider Business Mailing Address City Name:
MONTEREY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93940-4539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
831-372-2169
Provider Business Mailing Address Fax Number:
831-372-6323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2265 41ST AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAPITOLA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95010-2039
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-372-2169
Provider Business Practice Location Address Fax Number:
831-372-6323
Provider Enumeration Date:
05/24/2012

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
831-372-2169

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)





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