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NPI Code Detail

MEDICARE: PACIFIC SURGICAL ASSOCIATES, A MEDICAL CORPORATION

MEDICARE: PACIFIC SURGICAL ASSOCIATES, A MEDICAL CORPORATION
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery Physician

General Provider Information

NPI Number : 1619111572
Entity Type Code : Organization
Provider Name (Legal Business Name) : PACIFIC SURGICAL ASSOCIATES, A MEDICAL CORPORATION
Provider Business Mailing Address
First Line : PO BOX 940358
Second Line :
City : SIMI VALLEY
State : CA
Zip : 93094-0358
Country : US
Telephone Number : 805-581-5575
Fax Number : 949-258-5984
Provider Business Practice Location Address
First Line : 2216 NEWPORT BLVD
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-1711
Country : US
Telephone Number : 805-581-5575
Fax Number : 949-258-5984
Authorized Official
Title or Position : OWNER
Name : JAY W CALVERT
Credential : M.D.
Telephone Number : 805-581-5575
Provider Enumeration Date : 04/22/2009
Last Update Date : 08/17/2009

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Directions to “PACIFIC SURGICAL ASSOCIATES, A MEDICAL CORPORATION ” Practice Location

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