Provider Demographics
NPI:1750530143
Name:SURGICAL PHYSICIAN ASSISTANT SERVICES INCORPORATED
Entity type:Organization
Organization Name:SURGICAL PHYSICIAN ASSISTANT SERVICES INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:MATTHEW
Authorized Official - Last Name:MAZZARESE
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:858-943-1588
Mailing Address - Street 1:839 VIA BARQUERO
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92069-7395
Mailing Address - Country:US
Mailing Address - Phone:858-349-1588
Mailing Address - Fax:
Practice Address - Street 1:839 VIA BARQUERO
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92069-7395
Practice Address - Country:US
Practice Address - Phone:858-349-1588
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-10
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty