Provider Demographics
NPI:1912441130
Name:CENTER FOR REGENERATIVE SURGERY
Entity Type:Organization
Organization Name:CENTER FOR REGENERATIVE SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NOAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:707-935-5600
Mailing Address - Street 1:1599 TARA HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PINOLE
Mailing Address - State:CA
Mailing Address - Zip Code:94564-2519
Mailing Address - Country:US
Mailing Address - Phone:510-815-9370
Mailing Address - Fax:510-298-5627
Practice Address - Street 1:1599 TARA HILLS DR
Practice Address - Street 2:
Practice Address - City:PINOLE
Practice Address - State:CA
Practice Address - Zip Code:94564-2519
Practice Address - Country:US
Practice Address - Phone:510-815-9370
Practice Address - Fax:510-298-5627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical