Provider Demographics
NPI:1548547532
Name:PHYSICIAN ASSISTANT SURGICAL SPECIALISTS, INC.
Entity type:Organization
Organization Name:PHYSICIAN ASSISTANT SURGICAL SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:SHERRYL
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BEH
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:310-937-3919
Mailing Address - Street 1:2118 WILSHIRE BLVD
Mailing Address - Street 2:#1171
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-5704
Mailing Address - Country:US
Mailing Address - Phone:310-937-3919
Mailing Address - Fax:310-376-9037
Practice Address - Street 1:2121 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2303
Practice Address - Country:US
Practice Address - Phone:310-937-3919
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty