Provider Demographics
NPI:1366012171
Name:NORTHGATE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:NORTHGATE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAREK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:831-588-7296
Mailing Address - Street 1:200 PORTER DR STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-1524
Mailing Address - Country:US
Mailing Address - Phone:831-588-7296
Mailing Address - Fax:
Practice Address - Street 1:200 PORTER DR STE 100
Practice Address - Street 2:
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-1524
Practice Address - Country:US
Practice Address - Phone:831-588-7296
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-25
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical