Healthcare Provider Details

I. General information

NPI: 1265617591
Provider Name (Legal Business Name): GOLD COAST SURGICAL ASSISTANTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2008
Last Update Date: 01/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 14TH ST
LOS OSOS CA
93402-1412
US

IV. Provider business mailing address

1360 14TH ST
LOS OSOS CA
93402-1412
US

V. Phone/Fax

Practice location:
  • Phone: 805-528-3284
  • Fax: 805-534-1159
Mailing address:
  • Phone: 805-528-3284
  • Fax: 805-534-1159

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number191240
License Number StateCA

VIII. Authorized Official

Name: MRS. CECELIA MAY DEAN
Title or Position: PRESIDENT
Credential: RNFA
Phone: 805-528-3284