Provider Demographics
NPI:1104632249
Name:CENTRAL CALIFORNIA BARIATRIC SURGERY, PARTNERSHIP
Entity type:Organization
Organization Name:CENTRAL CALIFORNIA BARIATRIC SURGERY, PARTNERSHIP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/ PARTNER / CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-248-7168
Mailing Address - Street 1:1552 COFFEE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3122
Mailing Address - Country:US
Mailing Address - Phone:209-248-7168
Mailing Address - Fax:209-248-0995
Practice Address - Street 1:1001 SYLVAN AVE STE A
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-1699
Practice Address - Country:US
Practice Address - Phone:209-248-7168
Practice Address - Fax:209-248-0995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-04
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty