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General NPI Number Information
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NPI Number | 1619544178
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Entity Type | Organization
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Legal Business Name | SURGICAL PHYSICIAN ASSISTANT SPECIALIST, INC.
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Dates
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Enumeration Date | 06/04/2021
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 5555 GROSSMONT CENTER DR
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City | LA MESA
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State | CA
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Zip | 91942-3019
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Country | US
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Telephone | 619-740-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 21ST ST STE R
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City | SACRAMENTO
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State | CA
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Zip | 95811-5226
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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 | OWNER
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Name | ZACHARY PERIHAROS
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Credential |
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Telephone | 978-822-6348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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