Provider Demographics
NPI:1184831489
Name:SAN LEANDRO SURGERY CENTER
Entity type:Organization
Organization Name:SAN LEANDRO SURGERY CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:L
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:510-276-2800
Mailing Address - Street 1:15035 E 14TH ST
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 ST
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:2007-05-17
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes293D00000XLaboratoriesPhysiological Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ15774ZMedicare PIN