Provider Demographics
NPI:1205897592
Name:SURGICAL ASSOCIATES OF SAN DIEGO PC
Entity type:Organization
Organization Name:SURGICAL ASSOCIATES OF SAN DIEGO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BULKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-325-2612
Mailing Address - Street 1:PO BOX 462079
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92046-2079
Mailing Address - Country:US
Mailing Address - Phone:760-739-7666
Mailing Address - Fax:760-739-7633
Practice Address - Street 1:625 W CITRACADO PKWY
Practice Address - Street 2:SUITE 203
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025
Practice Address - Country:US
Practice Address - Phone:760-739-7666
Practice Address - Fax:760-739-7633
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-28
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA120589Medicare UPIN
CAW19003Medicare UPIN
CAW19003Medicare UPIN