Provider Demographics
NPI:1568696987
Name:DOCTORS MEDICAL SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:DOCTORS MEDICAL SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:I
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-690-0558
Mailing Address - Street 1:PO BOX 20609
Mailing Address - Street 2:
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-8609
Mailing Address - Country:US
Mailing Address - Phone:510-690-0558
Mailing Address - Fax:510-690-1894
Practice Address - Street 1:20055 LAKE CHABOT RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5331
Practice Address - Country:US
Practice Address - Phone:510-690-0558
Practice Address - Fax:510-690-1894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA46526174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A465260Medicaid
CA00A465260Medicaid
CAF62767Medicare UPIN