Provider Demographics
NPI:1831664986
Name:BAY AREA SURGICAL ASSOCIATES, LLC
Entity Type:Organization
Organization Name:BAY AREA SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TEODORO
Authorized Official - Middle Name:
Authorized Official - Last Name:NISSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-724-6549
Mailing Address - Street 1:1599 TARA HILLS DRIVE
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564
Mailing Address - Country:US
Mailing Address - Phone:510-724-6549
Mailing Address - Fax:510-724-6591
Practice Address - Street 1:1599 TARA HILLS DRIVE
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564
Practice Address - Country:US
Practice Address - Phone:510-724-6549
Practice Address - Fax:510-724-6591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-04
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical