Provider Demographics
NPI:1235669268
Name:PHYSICIAN ASSISTANT SURGASSIST, INC.
Entity Type:Organization
Organization Name:PHYSICIAN ASSISTANT SURGASSIST, INC.
Other - Org Name:SURGASSIST, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANGEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANAK-AGUNG-GEDE
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:951-206-2347
Mailing Address - Street 1:1250 SANTA CORA AVE APT 627
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91913-1555
Mailing Address - Country:US
Mailing Address - Phone:951-206-2347
Mailing Address - Fax:
Practice Address - Street 1:5555 GROSSMONT CENTER DR
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3019
Practice Address - Country:US
Practice Address - Phone:619-740-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty