Basic Information
| Provider Information | |||||||||
| NPI: | 1750827606 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PREMIER SURGICAL ASSISTANTS, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3590 CAMINO DEL RIO N | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921081707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585131833 | ||||||||
| FaxNumber: | 8585131838 | ||||||||
| Practice Location | |||||||||
| Address1: | 3590 CAMINO DEL RIO N | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921081707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8585131833 | ||||||||
| FaxNumber: | 8585131838 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2017 | ||||||||
| LastUpdateDate: | 01/18/2017 | ||||||||
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| AuthorizedOfficialLastName: | GHOSH | ||||||||
| AuthorizedOfficialFirstName: | SANJAY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | NEUROSURGEON | ||||||||
| AuthorizedOfficialTelephone: | 8585131833 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146N00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Emergency Medical Service Providers | Emergency Medical Technician, Basic |
No ID Information.