Provider Demographics
NPI:1629581681
Name:PAMELA L KURTZHALS MD FACS A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PAMELA L KURTZHALS MD FACS A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KURTZHALS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:619-354-2777
Mailing Address - Street 1:3075 HEALTH CENTER DR STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2773
Mailing Address - Country:US
Mailing Address - Phone:619-354-2777
Mailing Address - Fax:619-342-9411
Practice Address - Street 1:3075 HEALTH CENTER DR STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2773
Practice Address - Country:US
Practice Address - Phone:619-354-2777
Practice Address - Fax:619-342-9411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-13
Last Update Date:2017-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty