Provider Demographics
NPI:1417220609
Name:WEST COAST SURGICAL ASSISTANTS
Entity Type:Organization
Organization Name:WEST COAST SURGICAL ASSISTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMONDS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:1619-985-7698
Mailing Address - Street 1:10755 SCRIPPS POWAY PKWY
Mailing Address - Street 2:SUITE 383
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3924
Mailing Address - Country:US
Mailing Address - Phone:161-998-5769
Mailing Address - Fax:
Practice Address - Street 1:10755 SCRIPPS POWAY PKWY
Practice Address - Street 2:SUITE 383
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3924
Practice Address - Country:US
Practice Address - Phone:161-998-5769
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-17
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69685363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty