Provider Demographics
NPI:1811284870
Name:SURGICAL ASSIST OF NORTHERN CALIFORNIA
Entity type:Organization
Organization Name:SURGICAL ASSIST OF NORTHERN CALIFORNIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:LEER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-362-0695
Mailing Address - Street 1:PO BOX 320896
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-0114
Mailing Address - Country:US
Mailing Address - Phone:925-362-0695
Mailing Address - Fax:925-362-0695
Practice Address - Street 1:53 SAINT MARK CT
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-5326
Practice Address - Country:US
Practice Address - Phone:925-362-0695
Practice Address - Fax:925-362-0695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-28
Last Update Date:2012-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA065099208600000X
CAOPA16571363AS0400X
CAA82314208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Multi-Specialty