Provider Demographics
NPI:1689905515
Name:FREMONT AMBULATORY SURGERY CENTER, L.P.
Entity Type:Organization
Organization Name:FREMONT AMBULATORY SURGERY CENTER, L.P.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZOROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-793-4987
Mailing Address - Street 1:39350 CIVIC CENTER DR
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2343
Mailing Address - Country:US
Mailing Address - Phone:510-793-4987
Mailing Address - Fax:
Practice Address - Street 1:39350 CIVIC CENTER DR
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2343
Practice Address - Country:US
Practice Address - Phone:510-793-4987
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical