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General NPI Number Information
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NPI Number | 1417220609
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Entity Type | Organization
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Legal Business Name | WEST COAST SURGICAL ASSISTANTS
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Dates
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Enumeration Date | 02/17/2012
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Last Update Date | 02/17/2012
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Provider Practice Location Address
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Address Line | 10755 SCRIPPS POWAY PKWY SUITE 383
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City | SAN DIEGO
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State | CA
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Zip | 92131-3924
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Country | US
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Telephone | 161-998-5769
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Fax |
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Provider Business Mailing Address
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Address Line | 10755 SCRIPPS POWAY PKWY SUITE 383
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City | SAN DIEGO
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State | CA
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Zip | 92131-3924
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Country | US
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Telephone | 161-998-5769
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | MR. TOMMY HAMMONDS
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Credential |
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Telephone | 16199857698
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | G69685
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License Number State | CA
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