Provider Demographics
NPI:1952466716
Name:EL CAMINO SURGERY CENTER
Entity Type:Organization
Organization Name:EL CAMINO SURGERY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:650-961-1200
Mailing Address - Street 1:2480 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-4300
Mailing Address - Country:US
Mailing Address - Phone:650-961-1200
Mailing Address - Fax:650-960-7041
Practice Address - Street 1:2480 GRANT RD
Practice Address - Street 2:
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-4300
Practice Address - Country:US
Practice Address - Phone:650-961-1200
Practice Address - Fax:650-960-7041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA220000261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
220000OtherCA LICENSE NUMBER
CASURO1212FMedicaid
=========OtherTAX ID NUMBER
CAZZZ30698ZMedicare ID - Type Unspecified