Healthcare Provider Details

I. General information

NPI: 1730729690
Provider Name (Legal Business Name): PRECISION PHYSICIANS SURGICAL GROUP CORP.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2020
Last Update Date: 01/08/2020
Certification Date: 01/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 JENSEN CT STE 1C
THOUSAND OAKS CA
91360-7484
US

IV. Provider business mailing address

PO BOX 8636
CALABASAS CA
91372-8636
US

V. Phone/Fax

Practice location:
  • Phone: 678-596-1344
  • Fax:
Mailing address:
  • Phone: 770-815-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: REETU DUA
Title or Position: VICE PRESIDENT
Credential:
Phone: 770-815-6466