Provider Demographics
NPI:1447216106
Name:OBSTETRICS AND GYNECOLOGY SURGICAL ASSOCIATES OF SAN DIEGO MEDICAL GRO
Entity Type:Organization
Organization Name:OBSTETRICS AND GYNECOLOGY SURGICAL ASSOCIATES OF SAN DIEGO MEDICAL GRO
Other - Org Name:WEST COAST OBSTETRICS AND GYNECOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:S
Authorized Official - Last Name:SAFFER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-277-9378
Mailing Address - Street 1:7695 CARDINAL CT
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-3357
Mailing Address - Country:US
Mailing Address - Phone:858-277-9378
Mailing Address - Fax:858-277-9370
Practice Address - Street 1:7695 CARDINAL CT
Practice Address - Street 2:SUITE 240
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-3357
Practice Address - Country:US
Practice Address - Phone:858-277-9378
Practice Address - Fax:858-277-9370
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI48480Medicare UPIN
CAWA92651AMedicare ID - Type Unspecified