institution
4th Street Laser & Surgery Center Inc
Ambulatory Surgical Clinic/Center in Santa Rosa, California
NPI 1902964174

4th Street Laser & Surgery Center Inc is an Ambulatory Surgical Clinic/Center based in Santa Rosa, CA and is specialized in Ambulatory Surgical. 4th Street Laser & Surgery Center Inc practices in Santa Rosa, CA. The NPI Number for 4th Street Laser & Surgery Center Inc is 1902964174 and holds a License No. 110000344 (California).

The current practice location address for 4th Street Laser & Surgery Center Inc is 1720 4Th St, Santa Rosa, CA and can be reached out via phone at 707-546-8100 and via fax at 707-544-6438.

Location: 1720 4Th St, Santa Rosa, CA, 95404-3602
institution
Provider Profile Details
NPI Number
1902964174
Provider Name
4th Street Laser & Surgery Center Inc
Credential
Provider Entity Type
Organization
Address
1720 4Th St, Santa Rosa, CA, 95404-3602
Phone Number
707-546-8100
Fax Number
707-544-6438
Provider Enumeration Date
12/04/2006
Last Update Date
03/08/2024
tick
Provider's Legacy Identifiers
Identifier Type State Issuer
SUR01428G 05 CA
110000344 01 CA STATE OF CA LICENSE
institution
Provider Business Practice Location Address Details
Address
1720 4Th St
City
State
Zip
95404-3602
Phone Number
707-546-8100
Fax Number
707-544-6438
person
Provider Business Mailing Address Details
Address
1720 4Th St
City
State
Zip
95404-3602
Phone Number
707-546-8100
Fax Number
707-544-6438
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Ambulatory Surgical
Taxonomy
License No.
110000344 (California)
Definition
Definition to come...
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