Provider Demographics
NPI:1205036928
Name:SYLVIA SURGICAL ASSISTANT, INC.
Entity Type:Organization
Organization Name:SYLVIA SURGICAL ASSISTANT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CECIL
Authorized Official - Middle Name:
Authorized Official - Last Name:REYES
Authorized Official - Suffix:
Authorized Official - Credentials:PAC
Authorized Official - Phone:562-708-9729
Mailing Address - Street 1:PO BOX 4808
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90241-1808
Mailing Address - Country:US
Mailing Address - Phone:562-702-9729
Mailing Address - Fax:
Practice Address - Street 1:7033 STEWART AND GRAY RD UNIT 38
Practice Address - Street 2:
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90241-4355
Practice Address - Country:US
Practice Address - Phone:562-708-9729
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-20
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16338363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW22619Medicare PIN