Provider Demographics
NPI:1952302895
Name:SAN LEANDRO SURGERY CENTER LTD A CALIFORNIA LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:SAN LEANDRO SURGERY CENTER LTD A CALIFORNIA LIMITED PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:LINDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-276-2800
Mailing Address - Street 1:15035 E 14TH STREET
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-1901
Mailing Address - Country:US
Mailing Address - Phone:510-276-2800
Mailing Address - Fax:510-276-6896
Practice Address - Street 1:15035 E 14TH STREET
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1901
Practice Address - Country:US
Practice Address - Phone:510-276-2800
Practice Address - Fax:510-276-6896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA140000348261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ25638ZMedicare PIN