Provider Demographics
NPI:1780996868
Name:FREMONT SURGERY CENTER NORTH
Entity type:Organization
Organization Name:FREMONT SURGERY CENTER NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAZOROS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-456-4600
Mailing Address - Street 1:39350 CIVIC CENTER DR STE 280
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2331
Mailing Address - Country:US
Mailing Address - Phone:510-456-4600
Mailing Address - Fax:510-456-1006
Practice Address - Street 1:39472 PASEO PADRE PKWY
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2310
Practice Address - Country:US
Practice Address - Phone:510-456-4600
Practice Address - Fax:510-794-6822
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-06
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical