Provider Demographics
NPI: | 1639930647 |
---|---|
Name: | TRAUMA AND ACUTE CARE SURGERY SPECIALISTS INC |
Entity Type: | Organization |
Organization Name: | TRAUMA AND ACUTE CARE SURGERY SPECIALISTS INC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | NOOR |
Authorized Official - Middle Name: | SABA |
Authorized Official - Last Name: | AZIMI |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MD |
Authorized Official - Phone: | 510-390-4028 |
Mailing Address - Street 1: | 19331 BARCLAY RD |
Mailing Address - Street 2: | |
Mailing Address - City: | CASTRO VALLEY |
Mailing Address - State: | CA |
Mailing Address - Zip Code: | 94546-3252 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 510-390-4028 |
Mailing Address - Fax: | 510-743-0767 |
Practice Address - Street 1: | 20103 LAKE CHABOT RD |
Practice Address - Street 2: | |
Practice Address - City: | CASTRO VALLEY |
Practice Address - State: | CA |
Practice Address - Zip Code: | 94546-5305 |
Practice Address - Country: | US |
Practice Address - Phone: | 510-390-4028 |
Practice Address - Fax: | 510-743-0767 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2024-01-17 |
Last Update Date: | 2024-01-17 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Single Specialty |