Healthcare Provider Details

I. General information

NPI: 1093059248
Provider Name (Legal Business Name): PHYSICIAN ASSISTANT SURGICAL ASSIST, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2012
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6520 LONETREE BLVD STE 2009
ROCKLIN CA
95765-5874
US

IV. Provider business mailing address

6520 LONETREE BLVD STE 2009
ROCKLIN CA
95765-5874
US

V. Phone/Fax

Practice location:
  • Phone: 702-458-2304
  • Fax:
Mailing address:
  • Phone: 702-458-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: CHAD SPEARS
Title or Position: OWNER
Credential: PA-C
Phone: 702-458-2304