Healthcare Provider Details

I. General information

NPI: 1881913960
Provider Name (Legal Business Name): ASSIST SURGERY JOHN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2010
Last Update Date: 10/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2110 FOREST AVE
SAN JOSE CA
95128-1469
US

IV. Provider business mailing address

32108 ALVARADO BLVD # 285
UNION CITY CA
94587-4000
US

V. Phone/Fax

Practice location:
  • Phone: 408-834-3348
  • Fax:
Mailing address:
  • Phone: 408-834-3348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number
License Number State

VIII. Authorized Official

Name: MR. FLORENCIO A MEDINA
Title or Position: OWNER
Credential: RNFA
Phone: 408-984-2455