Provider Demographics
NPI:1700175189
Name:EAST BAY AMBULATORY SURGERY CENTER LLC
Entity type:Organization
Organization Name:EAST BAY AMBULATORY SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASTILLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:424-249-3783
Mailing Address - Street 1:9190 W OLYMPIC BLVD
Mailing Address - Street 2:STE 139
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3540
Mailing Address - Country:US
Mailing Address - Phone:414-249-3783
Mailing Address - Fax:
Practice Address - Street 1:1860 MOWRY AVE
Practice Address - Street 2:STE 401 & 402
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1730
Practice Address - Country:US
Practice Address - Phone:424-249-3783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84519173000000X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No173000000XOther Service ProvidersLegal MedicineGroup - Multi-Specialty