Provider Demographics
NPI:1386982338
Name:AMBULATORY SURGERY CENTER OF NAPA
Entity type:Organization
Organization Name:AMBULATORY SURGERY CENTER OF NAPA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:D
Authorized Official - Last Name:POLITZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-255-5033
Mailing Address - Street 1:3301 VILLA LN
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-3087
Mailing Address - Country:US
Mailing Address - Phone:707-255-5033
Mailing Address - Fax:707-255-1554
Practice Address - Street 1:3301 VILLA LN
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-3087
Practice Address - Country:US
Practice Address - Phone:707-255-5033
Practice Address - Fax:707-255-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-26
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4663OtherAAAASF