Provider Demographics
NPI:1235569799
Name:SCURR, MARTHA (PA)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:
Last Name:SCURR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARTHA
Other - Middle Name:
Other - Last Name:FISIC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:2879 REGIS LN
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4210
Mailing Address - Country:US
Mailing Address - Phone:714-624-6847
Mailing Address - Fax:
Practice Address - Street 1:26730 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6364
Practice Address - Country:US
Practice Address - Phone:949-364-2154
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-20
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51261363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical