Healthcare Provider Details

I. General information

NPI: 1598949281
Provider Name (Legal Business Name): POWAY CA MULTI SPECIALTY ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 01/20/2023
Certification Date: 01/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15611 POMERADO RD STE 220
POWAY CA
92064-2437
US

IV. Provider business mailing address

1A BURTON HILLS BLVD. LICENSURE AND CERT DEPT
NASHVILLE TN
37215-6187
US

V. Phone/Fax

Practice location:
  • Phone: 858-521-0031
  • Fax: 858-521-0921
Mailing address:
  • Phone: 615-263-4011
  • 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: MR. JEFFREY SNODGRASS
Title or Position: PRESIDENT
Credential:
Phone: 615-665-1283