Provider Demographics
NPI:1952327165
Name:SURGICAL ASSOCIATES OF LA JOLLA MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:SURGICAL ASSOCIATES OF LA JOLLA MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HYDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-452-5054
Mailing Address - Street 1:9850 GENESEE AVE
Mailing Address - Street 2:SUITE 660
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1224
Mailing Address - Country:US
Mailing Address - Phone:858-452-5054
Mailing Address - Fax:858-452-5097
Practice Address - Street 1:9850 GENESEE AVE
Practice Address - Street 2:SUITE 660
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1224
Practice Address - Country:US
Practice Address - Phone:858-452-5054
Practice Address - Fax:858-452-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0087870Medicaid
CAW13229Medicare ID - Type Unspecified