Organization · NPI-2

Blue Sky Surgical

Registered Nurse, Registered Nurse First Assistant · San Jose, CA

NPI number1104714963
StatusActive
Last updated in NPPESNov 15, 2025

Details

NPI
1104714963
Entity type
Organization (NPI-2)
Legal business name
Blue Sky Surgical
Organization subpart
No
Enumeration date
Jun 27, 2025
Certification date
Nov 15, 2025
Last updated
Nov 15, 2025

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
163WR0006X Registered Nurse, Registered Nurse First Assistant––Yes
251J00000X Nursing Care––

Practice location

2951 Wall St
San Jose, CA 95111-4600

Phone 408-603-6553

Mailing address

2951 Wall St
San Jose, CA 95111-4600

Phone 650-935-4745

Authorized official

Jenny Phan
Owner
6509354745

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