Healthcare Provider Details

I. General information

NPI: 1093009482
Provider Name (Legal Business Name): FIRST ASSIST SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2011
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 BROOKE ACRES DR
LOS GATOS CA
95032-6462
US

IV. Provider business mailing address

405 SUNOL ST
SAN JOSE CA
95126-3750
US

V. Phone/Fax

Practice location:
  • Phone: 408-656-9049
  • Fax: 408-879-6204
Mailing address:
  • Phone: 408-656-9049
  • Fax: 408-879-6204

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number257522-4568
License Number StateCA

VIII. Authorized Official

Name: KIRSTEN DUGGINS
Title or Position: OWNER
Credential:
Phone: 408-656-9049