Provider Demographics
NPI:1043616600
Name:BAY AREA SURGICAL SPECIALISTS, INC
Entity type:Organization
Organization Name:BAY AREA SURGICAL SPECIALISTS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:INEZ
Authorized Official - Middle Name:
Authorized Official - Last Name:WONDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-948-8143
Mailing Address - Street 1:2637 SHADELANDS DR
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-2512
Mailing Address - Country:US
Mailing Address - Phone:925-948-8143
Mailing Address - Fax:925-627-3560
Practice Address - Street 1:390 N WIGET LN STE 100
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-2450
Practice Address - Country:US
Practice Address - Phone:925-944-0110
Practice Address - Fax:925-944-0960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-10
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA42343207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
7360010001OtherNSC MEDICARE
7360010001OtherNSC MEDICARE