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General NPI Number Information
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NPI Number | 1588909097
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Entity Type | Organization
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Legal Business Name | SAN DIEGO ADVANCED SURGERY P.C.
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 12/10/2012
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Provider Practice Location Address
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Address Line | 3245 UNIVERSITY AVE # 501
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City | SAN DIEGO
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State | CA
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Zip | 92104-2009
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Country | US
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Telephone | 858-964-0661
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Fax |
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Provider Business Mailing Address
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Address Line | 3245 UNIVERSITY AVE # 501
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City | SAN DIEGO
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State | CA
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Zip | 92104-2009
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HERMAN SKOROBOGATY
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Credential | M.D.
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Telephone | 916-471-9150
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A105847
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License Number State | CA
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