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General NPI Number Information
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NPI Number | 1154554160
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Entity Type | Organization
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Legal Business Name | CABRILLO SURGERY CENTER
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Dates
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Enumeration Date | 08/25/2009
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Last Update Date | 03/08/2023
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Provider Practice Location Address
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Address Line | 7695 CARDINAL CT SUITE 220
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City | SAN DIEGO
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State | CA
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Zip | 92123-3357
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Country | US
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Telephone | 858-278-8835
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Fax | 858-386-4776
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Provider Business Mailing Address
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Address Line | 7695 CARDINAL CT SUITE 220
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City | SAN DIEGO
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State | CA
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Zip | 92123-3357
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Country | US
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Telephone | 858-278-8835
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Fax | 858-386-4776
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Authorized Official
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Title or Position | CEO
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Name | DR. WALTER K NAHM
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Credential | MD
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Telephone | 858-278-8835
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | A78569
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License Number State | CA
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