Basic Information
| Provider Information | |||||||||
| NPI: | 1376626226 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WALNUT CREEK SURGICAL ASSOICATES, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 130 LA CASA VIA | ||||||||
| Address2: | BUILDING 3, SUITE 211 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259330984 | ||||||||
| FaxNumber: | 9259330986 | ||||||||
| Practice Location | |||||||||
| Address1: | 130 LA CASA VIA | ||||||||
| Address2: | BUILDING 3, SUITE 211 | ||||||||
| City: | WALNUT CREEK | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945983045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259330984 | ||||||||
| FaxNumber: | 9259330986 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/23/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | BAKER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | STEPHEN | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 9259330984 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.