Provider Demographics
NPI:1427366053
Name:TOWNSEND SURGICAL SERVICES
Entity Type:Organization
Organization Name:TOWNSEND SURGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:TOWNSEND
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:951-924-4700
Mailing Address - Street 1:PO BOX 9367
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92552-9367
Mailing Address - Country:US
Mailing Address - Phone:760-668-6776
Mailing Address - Fax:951-924-1320
Practice Address - Street 1:12979 MORENO BEACH DR
Practice Address - Street 2:SUITE 12303
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4431
Practice Address - Country:US
Practice Address - Phone:760-668-6776
Practice Address - Fax:951-924-4700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-16
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16781363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA167810OtherPTAN