Provider Demographics
NPI:1093009482
Name:FIRST ASSIST SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:FIRST ASSIST SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIRSTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUGGINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:408-656-9049
Mailing Address - Street 1:405 SUNOL ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3750
Mailing Address - Country:US
Mailing Address - Phone:408-656-9049
Mailing Address - Fax:408-879-6204
Practice Address - Street 1:221 BROOKE ACRES DR
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-6462
Practice Address - Country:US
Practice Address - Phone:408-656-9049
Practice Address - Fax:408-879-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-03
Last Update Date:2014-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208600000X, 363A00000X, 363AS0400X, 363L00000X
CA257522-4568363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty