=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396079687
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SAN DIEGO SURGICAL ASSISTANTS, INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2009
-----------------------------------------------------
Last Update Date | 09/20/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9850 GENESEE AVE STE 640
-----------------------------------------------------
City | LA JOLLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92037-1217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-677-0777
-----------------------------------------------------
Fax | 858-677-0666
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9850 GENESEE AVE STE 640
-----------------------------------------------------
City | LA JOLLA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92037-1217
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-677-0777
-----------------------------------------------------
Fax | 858-677-0666
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MEL KURTULUS
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 858-677-0777
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207VG0400X
-----------------------------------------------------
Taxonomy Name | Gynecology Physician
-----------------------------------------------------
License Number | A72728
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------