Organization
EXECUTIVE ENDOSCOPY, INC
Active
Other names
Endoscopy Center of San Jose
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARIBEL RIVERA (OFFICE MANAGER)
(408) 297-2314
Entity
Organization
Contact information
Practice address
2100 FOREST AVE, 109, SAN JOSE, CA 95128-1422
(408) 297-2314
(408) 297-2414
Mailing address
2100 FOREST AVE, 109, SAN JOSE, CA 95128-1422
(408) 297-2314
(408) 297-2414
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SUR01553F
—
CA
Enumeration date
10/04/2005
Last updated
08/22/2020
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