Provider Demographics
NPI:1285612812
Name:ENDOSCOPY CENTER OF SILICON VALLEY INC.
Entity type:Organization
Organization Name:ENDOSCOPY CENTER OF SILICON VALLEY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SONJA
Authorized Official - Middle Name:C
Authorized Official - Last Name:VON AHMEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:408-369-9798
Mailing Address - Street 1:2410 SAMARITAN DR
Mailing Address - Street 2:101
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124
Mailing Address - Country:US
Mailing Address - Phone:408-369-9798
Mailing Address - Fax:408-369-9895
Practice Address - Street 1:2410 SAMARITAN DR
Practice Address - Street 2:101
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124
Practice Address - Country:US
Practice Address - Phone:408-369-9798
Practice Address - Fax:408-369-9895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-04
Last Update Date:2009-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA070000622261QE0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0800XAmbulatory Health Care FacilitiesClinic/CenterEndoscopy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22697ZMedicare PIN