Healthcare Provider Details

I. General information

NPI: 1902923162
Provider Name (Legal Business Name): LA MESA MEDICAL AND SURGICAL CTR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/23/2007
Last Update Date: 12/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8401 GRANT AVE
LA MESA CA
91941-5303
US

IV. Provider business mailing address

8415 GRANT AVE
LA MESA CA
91941-5303
US

V. Phone/Fax

Practice location:
  • Phone: 619-460-2672
  • Fax:
Mailing address:
  • Phone: 619-460-2672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAYMOND SPLINTER
Title or Position: OWNER
Credential: M.D.
Phone: 619-460-2672