Provider Demographics
NPI:1922031525
Name:FIRST SURGICAL CONSULTANTS MEDICAL GROUP INC
Entity Type:Organization
Organization Name:FIRST SURGICAL CONSULTANTS MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:STANTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-465-5523
Mailing Address - Street 1:365 HAWTHORNE AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3107
Mailing Address - Country:US
Mailing Address - Phone:510-465-5523
Mailing Address - Fax:510-832-6061
Practice Address - Street 1:365 HAWTHORNE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3107
Practice Address - Country:US
Practice Address - Phone:510-465-5523
Practice Address - Fax:510-832-6061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1705695174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty