Basic Information
| Provider Information | |||||||||
| NPI: | 1699959387 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SAN DIEGO CA MULTI SPECIALTY ASC LLC | ||||||||
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| OtherOrganizationName: | MISSION VALLEY HEIGHTS SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7485 MISSION VALLEY RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921084422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192913737 | ||||||||
| FaxNumber: | 6192913738 | ||||||||
| Practice Location | |||||||||
| Address1: | 7485 MISSION VALLEY RD | ||||||||
| Address2: | SUITE 106 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921084422 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6192913737 | ||||||||
| FaxNumber: | 6192913738 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2007 | ||||||||
| LastUpdateDate: | 06/22/2022 | ||||||||
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| AuthorizedOfficialLastName: | SNODGRASS | ||||||||
| AuthorizedOfficialFirstName: | JEFFREY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6156651283 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 06/22/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.