1861542755 NPI number — CENTER FOR SPECIAL MINIMALLY INVASIVE SURGERY

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 1861542755 NPI number — CENTER FOR SPECIAL MINIMALLY INVASIVE SURGERY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR SPECIAL MINIMALLY INVASIVE SURGERY
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:
1861542755
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 WELCH RD
Provider Second Line Business Mailing Address:
SUITE403
Provider Business Mailing Address City Name:
PALO ALTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94304-1805
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
650-327-8778
Provider Business Mailing Address Fax Number:
650-327-2794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 WELCH RD
Provider Second Line Business Practice Location Address:
SUITE403
Provider Business Practice Location Address City Name:
PALO ALTO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94304-1805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
650-327-8778
Provider Business Practice Location Address Fax Number:
650-327-2794
Provider Enumeration Date:
01/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NEZHAT
Authorized Official First Name:
CAMRAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OWNER
Authorized Official Telephone Number:
650-327-8778

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  A34341 , 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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