Provider Demographics
NPI:1619111572
Name:PACIFIC SURGICAL ASSOCIATES, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PACIFIC SURGICAL ASSOCIATES, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:W
Authorized Official - Last Name:CALVERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-581-5575
Mailing Address - Street 1:PO BOX 940358
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-0358
Mailing Address - Country:US
Mailing Address - Phone:805-581-5575
Mailing Address - Fax:949-258-5984
Practice Address - Street 1:2216 NEWPORT BLVD
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-1711
Practice Address - Country:US
Practice Address - Phone:805-581-5575
Practice Address - Fax:949-258-5984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2009-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty