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General NPI Number Information
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NPI Number | 1750530143
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Entity Type | Organization
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Legal Business Name | SURGICAL PHYSICIAN ASSISTANT SERVICES INCORPORATED
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Dates
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Enumeration Date | 09/10/2008
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Last Update Date | 01/05/2011
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Provider Practice Location Address
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Address Line | 839 VIA BARQUERO
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City | SAN MARCOS
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State | CA
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Zip | 92069-7395
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Country | US
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Telephone | 858-349-1588
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Fax |
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Provider Business Mailing Address
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Address Line | 839 VIA BARQUERO
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City | SAN MARCOS
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State | CA
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Zip | 92069-7395
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Country | US
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Telephone | 858-349-1588
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. PETER MATTHEW MAZZARESE
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Credential | PA
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Telephone | 858-943-1588
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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 |
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License Number State |
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