Organization
ASC NCA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS NICHOLS (AR DIRECTOR)
(586) 498-9440
Entity
Organization
Contact information
Practice address
15151 NATIONAL AVE, LOS GATOS, CA 95032-2627
(408) 358-4845
Mailing address
27087 GRATIOT AVE, ROSEVILLE, MI 48066-2947
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
—
Other
Enumeration date
03/15/2007
Last updated
08/22/2020
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