Provider Demographics
NPI:1235591496
Name:NORTHERN CALIFORNIA SURGICAL ENDOSCOPY, INC.
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA SURGICAL ENDOSCOPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CAMRAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEZHAT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:650-327-8778
Mailing Address - Street 1:240 MOUNTAIN WOOD LN
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:94062-2523
Mailing Address - Country:US
Mailing Address - Phone:650-327-8778
Mailing Address - Fax:650-327-2794
Practice Address - Street 1:240 MOUNTAIN WOOD LN
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:CA
Practice Address - Zip Code:94062-2523
Practice Address - Country:US
Practice Address - Phone:650-327-8778
Practice Address - Fax:650-327-2794
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-25
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34341174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty