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NPI Code Detail

MEDICARE: SURGICAL PHYSICIAN ASSISTANT SPECIALIST, INC.

MEDICARE: SURGICAL PHYSICIAN ASSISTANT SPECIALIST, INC.
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
1302F00000XExclusive Provider Organization

General Provider Information

NPI Number : 1619544178
Entity Type Code : Organization
Provider Name (Legal Business Name) : SURGICAL PHYSICIAN ASSISTANT SPECIALIST, INC.
Provider Business Mailing Address
First Line : 1401 21ST ST # 11082
Second Line :
City : SACRAMENTO
State : CA
Zip : 95811-5226
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5555 GROSSMONT CENTER DR
Second Line :
City : LA MESA
State : CA
Zip : 91942-3019
Country : US
Telephone Number : 619-740-6000
Fax Number :
Authorized Official
Title or Position : OWNER
Name : ZACHARY PERIHAROS
Credential :
Telephone Number : 530-232-5985
Provider Enumeration Date : 06/04/2021
Last Update Date : 01/22/2026

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Directions to “SURGICAL PHYSICIAN ASSISTANT SPECIALIST, INC. ” Practice Location

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