Organization
LASER SURGERY CENTER OF NORTHERN CALIFORNIA LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MICHELE E MCKINLEY (ADMINISTRATOR)
(925) 944-9400
Entity
Organization
Contact information
Practice address
2021 YGNACIO VALLEY RD, BLDG H STE 102, WALNUT CREEK, CA 94598
(925) 944-9400
(925) 947-2160
Mailing address
2021 YGNACIO VALLEY RD, BLDG H STE 102, WALNUT CREEK, CA 94598
(925) 944-9400
(925) 947-2160
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
140000518
LICENSE NUMBER
CA
05
—
SUR01367F
—
CA
Enumeration date
12/15/2006
Last updated
12/18/2013
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